Transplant renal artery stenosis

Abstract

Vascular complications after renal transplant are not common, but important cause of graft loss and graft failure. Transplant renal artery stenosis (TRAS) is the most common vascular complication. It usually occurs 3 months to 2 years after transplant. Stenosis may occur (1) at the anastomosis site, (2) as a focal stenosis either proximal or distal to anastomosis, or (3) as diffuse (narrowing of whole artery), multiple stenosis (simultaneous narrowing at multiple sites). Stenosis at site of anastomosis is common occurring in approximately 50% of cases and end-to-end anastomosis have a threefold greater risk of stenosis than end-to-side anastomosis. Usual clinical presentation of TRAS is resistant/worsening of hypertension with or without renal dysfunction. Color Doppler ultrasound is preferred method for screening and intraarterial angiography is gold standard for diagnosis of TRAS. Percutaneous transluminal renal angioplasty (PTRA) is treatment of choice for TRAS. Surgery is indicated for patients with unsuccessful angioplasty or with very severe stenosis that are inaccessible to PTRA.