Transplant renal artery stenosis (TRAS) after renal transplantation was underestimated because of the low sensitivity of ultrasound and the contrast induced renal damage on the renal allograft . New unenhanced magnetic resonance angiography by using spatial labeling with multiple inversion pulses can improve the sensitivity of vascular surgical complications without contrast induced renal damage. This study wants to observe the rate of TRAS after renal transplant patients through new MRA. Methodology: These patients with stable renal allograft function(defined with eGFR >60 ml/min)and the chronic renal allograft dysfunction(CRAD) (defined with eGFR<60 ml/min or increasing serum creatinine >30% of baseline)were selected in this study from Mar 2014 to Oct 2014. All CRAD patients underwent allograft biopsy. New unenhanced MRA and allograft ultrasound were used for observeing the TRAS and the perfusion of renal allograft. Result: 39 patients with stable allograft function and 36 CRAD patients received new MRA of the renal allograft. Exceeding our expectations, 30.7%(12/39) was diagnosed TRAS in stable allograft function group. The 3/3/6 were diagnosed with severe ( degree of stenosis>75%)/moderate(stenosis degree from 50% to 75%)/mild(stenosis degree from 25% to 50%). Cortical ADC_T, medullary ADC_T, medullary F_P were significantly lower in severe /moderate stenosis group compare to mild and no stenosis group. 33.3%(12/36) of CRAD patients were diagnosed with TRAS, 4/6/2 were diagnosed with severe /moderate/ mild stenosis. Only one patient (1/39) in stable group and two patients(2/36) in CRAD group were diagnosed with TRAS through ultrasound. Seven severe stenosis patients underwent DSA. The place and extent of TRAS were 100% matched between new unenhanced MRA and DSA. 12/36 TRAS patients in CRAD group diagnosed with BKVN(n=1),CNI nephrotoxicity(n=3) ,late AR(n=1),chronic rejection(n=2),borderline change(n=3),FSGS(n=1),TMA(n=1) by biopsy. Conclusion: TRAS was underestimated in renal transplant patients even in stable renal allograft function patients. New unenhanced MRA used in renal allograft can greatly improve the rate of diagnosis of TRAS contrast to ultrasound with excellent accuracy.

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