Long-term outcome of percutaneous transluminal renal angioplasty (PTRA) versus PTRA with stenting (PTRAS) in transplant renal artery stenosis

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; p. 212
• Main Authors: Wongpraparut, Nattawut, Chaipruckmalakarn, Thunyarat, Tongdee, Thongtum, Jaspttananon, Archan, Vongwiwatana, Attapong, Premasathian, Nalinee, Anusonadisai, Kawin, Pongakasira, Rungtiwa
• Format: Journal Article
• Language: English
• Published: England BioMed Central 26.04.2021; BMC
• Subjects: Adult; Anastomosis; Angioplasty; Angioplasty - adverse effects; Angioplasty - instrumentation; Antihypertensives; Bailouts; Blood & organ donations; Blood pressure; Cardiovascular system; Clinical trials; Databases, Factual; Epidermal growth factor receptors; Female; Glomerular filtration rate; Graft rejection; Grafts; Hospitals; Humans; Hypertension; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Long-term outcome; Male; Medical imaging; Medical records; Middle Aged; Patients; Percutaneous transluminal renal angioplasty (PTRA); Percutaneous transluminal renal angioplasty with stenting (PTRAS); Progression-Free Survival; Renal artery; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - epidemiology; Renal Artery Obstruction - therapy; Renal failure; Restenosis; Retrospective Studies; Risk Assessment; Risk Factors; Stenosis; Stents; Success; Survival; Survival analysis; Thailand - epidemiology; Time Factors; Transplant renal artery stenosis (TRAS); Veins & arteries; Thailand; Bangkok Thailand; Percutaneous transluminal renal angioplasty with stenting (PTRAS); Transplant renal artery stenosis (TRAS); Long-term outcome; Percutaneous transluminal renal angioplasty (PTRA)
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02015-4

Endovascular treatment is standard of care for transplant renal artery stenosis (TRAS). No study has evaluated long-term outcomes compared between percutaneous transluminal renal angioplasty (PTRA) and PTRA with stenting (PTRAS). Accordingly, this study aimed to investigate the 1-year clinical success, and short- and long-term event-free survival between PTRA and PTRAS in patients diagnosed with TRAS at Thailand's largest national tertiary referral center. This single-center retrospective study included kidney transplant patients treated for TRAS during January 2001 to June 2019. Clinical success was defined as (1) increase in estimated glomerular filtration rate (eGFR) > 15%, or (2) reduction in mean arterial pressure (MAP) > 15% with no decrease in antihypertensive medication, or no reduction in MAP or reduction in MAP < 15% with decrease in antihypertensive medication. Incidence of kidney transplant graft failure and transplant renal artery stenosis were also collected. Sixty-five cases of TRAS were identified from 1072 patients who underwent kidney transplantation. The majority (98.5%) had end-to-side anastomosis technique. Thirty-four patients had PTRA, while 31 patients had PTRAS. One-year clinical success according to renal outcome and BP reduction was 78.5% and 49.2%, respectively. Both renal outcome (79.4% vs. 77.4%, p = 0.845) and BP reduction (40.6% vs. 58.1%, p = 0.166) at 1 year were similar between the PTRA and PTRAS groups. Compared between PTRA and PTRAS, event-free survival for composite of kidney transplant graft failure or transplant renal artery restenosis was significantly higher for PTRAS at 1 year (82.4% vs. 100%, p = 0.025), but not significantly different at 10 years (73.5% vs. 71%, p = 0.818). We demonstrated the 1-year clinical success, and short- and long-term event-free survival between PTRA and PTRAS in TRAS patients. One-year clinical success was found to be similar between groups. Event-free survival for composite of kidney transplant graft failure or transplant renal artery restenosis was significantly higher in PTRAS at 1 year, but similar between groups at 10 years. Trial registration Thai Clinical Trials Registry, TCTR20200626002. Registered 26 June 2020-Retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trial search&smenu = fulltext&task = search&task2 = view1&id = 6441.