Dr Rohan Khanal1, Dr Murty Mantha1
1Cairns Hospital, Cairns, Australia
Background:
The incidence of transplant renal artery stenosis (TRAS) is between 1 to 23%. Whilst TRAS can occur anytime, it most commonly occurs between 3 months and 2 years post-transplantation. We present a case series of three patients with early TRAS and explore the impact of anatomical quality of donor and recipient vessels.
Cases:
Between 2017-2021, three renal allograft recipients aged between 49 and 55 experienced hemodynamically significant TRAS. The intraoperative findings reported that the arterial vessels of all three recipients were of good calibre with no macroscopic atheroma and all patients had a satisfactory end-to-side anastomosis. All three donors allografts had a single renal artery, but in one case a small calibre renal artery was noted. All donor arteries were noted to have macroscopic atheroma during the operation. The initial post-operative course was complicated by delayed graft function in two patients due to acute tubular necrosis. All three patients presented with persistent hypertension and graft dysfunction within 2-3 months of their transplantation and TRAS was suspected. They proceeded to have a renal doppler ultrasound which revealed raised peak systolic velocity (300-519 cm/sec) in the proximal renal artery. All cases proceeded to have balloon angioplasty with improvement in blood pressure and graft function. One patient required stent placement for recurrence of stenosis six months later.
Conclusions:
TRAS should be suspected in patients with persistent hypertension post-transplantation as it is potentially treatable condition. Atheromatous disease in the donor vessels appears to be a risk factor. Doppler ultrasonography can be used to detect most hemodynamically significant stenoses. Angioplasty is usually first line for patients with significant stenoses, but medical management or surgical intervention can be considered.
Biography:
Rohan is a first year advanced trainee in nephrology currently based at Cairns Hospital with an interest in general nephrology and public health