Long-term outcome of percutaneous transluminal renal angioplasty in transplant renal artery stenosis

• Published in: BMC cardiovascular disorders Vol. 21; no. 1
• Main Authors: Wongpraparut, Nattawut, Chaipruckmalakarn, Thunyarat, Tongdee, Thongtum, Jaspttananon, Archan, Vongwiwatana, Attapong, Premasathian, Nalinee, Anusonadisai, Kawin, Pongakasira, Rungtiwa
• Format: Journal Article
• Language: English
• Published: BioMed Central Ltd 26.04.2021
• Subjects: Angioplasty; Care and treatment; Comparative analysis; Diagnosis; Methods; Patient outcomes; Renal artery obstruction; Thailand
• DOI: 10.1186/s12872-021-02015-4
• ISSN: 1471-2261

Background 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. Methods 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. Results 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). Conclusions 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, Keywords: Percutaneous transluminal renal angioplasty (PTRA), Percutaneous transluminal renal angioplasty with stenting (PTRAS), Transplant renal artery stenosis (TRAS), Long-term outcome