*Purpose: Transplant renal artery stenosis (TRAS) is a treatable cause of renal allograft dysfunction. It presents commonly in the early post-transplant period with variable clinical presentation. The diagnosis is usually made on graft Doppler, yet angiography is required for confirmation. The risk factors associated with TRAS include Cytomegalovirus (CMV) infection, Delayed graft function (DGF), and prolonged cold ischemia time (CIT). However, these risk factors are less frequent in a living donor transplant. The present study aims to identify TRAS’s risk factors and outcome in kidney transplant recipients in a dominant living donor program.

*Methods: A nested case-control study with study period (2007-2020) December. TRAS group n-23 patients’ clinical parameters are compared with age and sex-matched control groups of 92 patients in the same year as a kidney transplant. Parametric and nonparametric univariate and multivariate analysis was done.

*Results: TRAS cases (n-23) presented from (15-173) with a mean of 104 days post-transplant with renal allograft dysfunction as the most common presenting features in 65% of cases. The initial diagnosis was made on graft Doppler. 20/23 patients were treated by angioplasty with stenting, and angioplasty alone was done in 3/23 patients with ostial TRAS. The duration of follow-up ranged from 6 months to 13 years. There were no interventional complications, and all recipients showed a significant reduction of Serum Creatinine (sCr) from mean sCr of 2.41 to 1.2 mg/dl. One patient died four years after intervention due to pneumonia. Hepatitis C infection, vascular reconstruction, End to side vascular anastomosis, DGF, and high immediate post-operative tacrolimus levels were independent risk factors for TRAS.

*Conclusions: Early endovascular intervention amends the allograft dysfunction with an excellent long-term outcome.

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