Tuesday July 03, 2018 from 09:45 to 11:15
Angioplasty Versus Medical Treatment of Transplant Renal Artery Stenosis: An Observational Prospective Study
Kajohnsak Noppakun1, Kamonphan Chanin1.
1Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background: Transplant renal artery stenosis (TRAS) is a recognized vascular complication after kidney transplantation and is associated with hypertension and poor allograft survival. Treatment of TRAS is primarily percutaneous intraluminal angioplasty with or without stent.
Objective: To compare outcomes of angioplasty versus medical treatment for the treatment of TRAS from 2000 to 2017.
Methods: We retrospectively reviewed transplant patients whom diagnosed TRAS by Duplex ultrasound. The clinical diagnosis of TRAS was based on uncontrolled hypertension and/or unexplained allograft dysfunction. Patients were divided into two groups: angioplasty group (percutaneous intraluminal angioplasty and surgical angioplasty) and medical treatment group.
Results: Of 166 patients screened for TRAS, 45 patients were diagnosed TRAS from Duplex ultrasound. Two patients were excluded from the analysis due to inadequate information. The median time of follow-up was 49.47 months (range, 3-140 months). Nineteen patients received angioplasty (17 patients with percutaneous intraluminal angioplasty and 2 patients with surgical angioplasty) and 23 patients receive medical treatment. Estimated glomerular filtration rate (eGFR) was significantly improved during the first 6 months after intervention in angioplasty group compared to medical treatment group (+2.68 ml/min/1.73 m2/month vs +0.17 ml/min/1.73 m2/month, p=0.006). However, change of eGFR after 6 months were not different between groups. The time to 30% increase of serum creatinine from baseline and allograft survival were not different between groups.
Conclusion: Angioplasty improved allograft function during the first 6 months after an intervention. However, long-term graft function and allograft survival were not different between treatment with angioplasty and medical treatment.