Endovascular Treatment of Transplant Renal Artery Stenosis: A Single-Center Retrospective Cohort Study

Objectives: Endovascular therapy is the most common treatment for transplant renal artery stenosis; however, its long-term outcomes remain controversial, with no uniform standard for percutaneous transluminal angioplasty versus percutaneous transluminal stenting. Materials and Methods: We retrospectively analyzed 26 patients with transplant renal artery stenosis who underwent endovascular therapy. We evaluated long-term efficacy of endovascular therapy and the reasonable choice of treatment. Results: Serum creatinine increased significantly at onset of transplant renal artery stenosis (113.88 +/- 37.573 before vs 279.31 +/- 94.98 mu mol/ L during stenosis; P-1 <.001), and endovascular therapy had a good short-term effect (279.31 +/- 94.98 during stenosis vs 139.54 +/- 124.40 mu mol/L at 2 weeks posttreatment; P-2 =.002). Long-term efficacy of endovascular therapy was stable (139.54 +/- 124.40 at 2 weeks posttreatment vs 150.69 +/- 180.72 at 6 months vs 161.58 +/- 174.49 mu mol/L at last follow-up; P-3 >.05). Blood pressure increased significantly at onset of transplant renal artery stenosis (126.65 +/- 16.11 before vs 159.62 +/- 25.84 mm Hg during stenosis; P-1 <.001). Moreover, the short-term effect of endovascular therapy was good (159.62 +/- 25.84 during stenosis vs 128.73 +/- 14.22 mm Hg at 2 weeks posttreatment; P-2 <.001). Long-term effects remained stable (128.73 +/- 14.22 at 2 weeks posttreatment vs 131.15 +/- 14.55 at 6 months vs 138.50 +/- 16.82 mm Hg at last follow- up; P-3 >.05). Peak systolic velocity decreased significantly after endovascular therapy (176.6 +/- 67.93 during stenosis vs 114.24 +/- 67.93 cm/s at 2 weeks posttreatment; P <.001). Conclusions: Endovascular therapy is effective in transplant renal artery stenosis treatment and has a low incidence of complications. Percutaneous transluminal angioplasty should be performed routinely during endovascular therapy. After dilation, if stenosis remains >25% or retracted, then percutaneous transluminal stenting is recommended. Otherwise, percutaneous transluminal angioplasty is preferred.