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High-grade renal transplant artery stenosis after suboptimal angioplasty: favourable long-term outcome.

Abstract：

:The purpose of our report is to present the long-term outcomes of three renal transplant recipients with high-grade stenosis and suboptimal percutaneous angioplasty (PTA) because of technical difficulties. Two men and one woman of age 67, 53, and 54 years, who maintained functional cadaveric graft for 17, 9, and 13 years, and had diagnosed significant renal transplant artery stenosis at 2, 1, and 2 years after renal transplantation, respectively, were studied. Stenoses were diagnosed angiographically in the first patient and by Doppler in other two patients, then confirmed by angiography. All three patients had difficult-to-treat hypertension with deterioration of graft function in the presence of or after introducing ACE-inhibitor therapy. PTA was performed in all patients with suboptimal or unsuccessful results as assessed by angiography or control Doppler examination--the residual stenosis was significant and practically unchanged. Surgery was not performed because of high risk, so patients were further treated conservatively. Hypertension was treated avoiding ACE inhibitors. Twelve, 7, and 7 years after angioplasty the serum creatinine is stable in all patients, even decreased compared to pre-PTA and early post-PTA levels, namely, 134, 102, and 75 micromol/L, respectively. Control Doppler examinations revealed a residual stenotic jet in all patients, with slightly decreased peak systolic velocity over time, indicating a slightly decreased grade of stenosis. These observations suggest that renal transplant artery stenosis, even of high grade, can be stable, or even regress with time with excellent long-term graft survival. Randomized studies comparing conservative treatment versus revascularization are warranted.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Buturović-Ponikvar J,Ponikvar R

doi

10.1016/j.transproceed.2003.10.003

subject

Has Abstract

pub_date

2003-12-01 00:00:00

pages

2891-3

issue

8

eissn

0041-1345

issn

1873-2623

pii

S0041134503010789

journal_volume

35

pub_type

杂志文章

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