Successful treatment of transplant renal artery stenosis with bare-metal stent in a patient with simultaneous pancreas and kidney transplantation

Abstract

Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after renal transplantation. It occurs most frequently in the first 6 months after renal transplantation and is a reversible cause of hypertension, volume overload, and graft dysfunction or graft loss. Early diagnosis and endovascular intervention (EVI) result in good outcome. The present report describes a challenging case of TRAS with diagnostic dilemma in a Type I diabetic patient with end-stage renal disease who had undergone a simultaneous pancreas and kidney transplantation. The patient had multiple risk factors for TRAS including atherosclerosis, interruption in immunosuppression due to subacute intestinal obstruction, antibody mediated rejection (ABMR) and tortuosity of the implanted artery. He presented with fluid retention and graft dysfunction without significant hypertension. He was initially diagnosed as ongoing ABMR for which he received antirejection therapy without any significant improvement. He was finally diagnosed as TRAS and successfully salvaged with EVI.