Kidney Complications (Videos Available)

Tuesday July 03, 2018 from 09:45 to 11:15

Room: N-107/108

421.8 Angioplasty versus medical treatment of transplant renal artery stenosis: An observational prospective study (Video Available)

Kajohnsak Noppakun, Thailand

Assistant Professor of Medicine
Renal Division, Department of Internal Medicine, Faculty of Medicine
Chiang Mai University

Abstract

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.



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