Purpose: The incidence of transplant renal artery stenosis (TRAS) ranges from 1 to 23% and is the most frequent vascular complication following renal transplantation. It can occur at the anastomosis site (AS), distal to it due to arterial kinking (AK) or due to intrinsic luminal shortening (LS). Percutaneous transluminal angioplasty (PTA) is the less invasive approach for initial management of TRAS with success rates higher than 80%. There is no study evaluating the site of TRAS with PTA successful rates.

Methods: From Jan 2005 to Dec 2011, 2221 renal transplants were performed. There were 22 patients with TRAS. They were classified as AS, AK or LS. The success of the procedures was considered by the analysis of 3 parameters: blood pressure control, amount of antihypertensive drugs and serum creatinine (Cr) levels. Evaluations of the parameters were made 1 week before PTA, and 2 days, 1 week, 1 month, 6 months, 1 year and 2 years after the procedure. Improvement Doppler ultrasonography parameters were also compared in the three groups.

Results: The mean time from transplantation to diagnosis was 145 ± 111 days. In 6 patients (27.3%) the site of stenosis was at the anastomosis (AS). In 3 (13.6%) cases, the TRAS was due to AK, and in 13 cases (59.1%) it was distal to the anastomosis. Mean diastolic blood pressure (DBP) showed a decrease of 23.4 33 mmHg and systolic blood pressure (SBP) 11.8 to 17.3 mmHg. Between the groups, there was no difference in SBP (p=0.34). However, the DBP decrease was higher in the kinking group (p=0.036). There was a dosage reduction of antihypertensive drugs in all cases. The mean drop of creatinine values from pre- to post-intervention was 0.72, 1.16, 1.38 and 2.28, 2.27 mg/dl according to the pre-established observation period (p<0.01). Cohorts were similar in terms of final Cr decrease. On Doppler study, mean blood flow speed was 210.6± 99.5 (2 days after transplantation), 417± 122.7 (TRAS diagnosis) and 182.5± 81.6 ml/sec (1 month after procedure) (p<0.001). No difference was found between the groups. After a mean follow up of 16± 4.2 months, the overall success rate was 100% with no complications or re-stenosis.

Conclusion: Endovascular PTA/stenting is a safe and effective procedure for all types of renal artery stenosis. There is a tendency for better results in the kinking subgroup.

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