MP739TRANSPLANT RENAL ARTERY STENOSIS : A CASE SERIES

Abstract

Introduction and Aims: Transplant renal artery stenosis (TRAS) may decrease the graft survival (67 versus 91% at 1-year post-transplant), and its management remains complex.We studied 24 TRAS patients in order to identify risk factors and analyze the benefits of angioplasty (ATL). Methods: This retrospective study identified 24 TRAS patients (TRAS+, n=24) in a French single-center from 2000 to 2015, and compared their pretransplant characteristics and outcome to 2 controls groups: 48 randomly selected controls (C1), and 20 recipients who received the contralateral kidney (C2). Results: Incidence of TRAS was 1,4%. Patients were predominantly males (71%), 52 ±13 years old, and treated by dialysis since 26 (range, 19-35) months before transplantation. Hypertension, dyslipidemia, diabetes, and active smoking were respectively reported in 59%, 29%, 17% and 8% of cases. TRAS mainly occurred during first transplantations (91%). 88% of them received a kidney from a 54±16 years old deceased donor (stroke 50%). Stenosis was diagnosed in average 5 months after transplantation and was frequently symptomatic: resistant hypertension (31%), acute renal failure (23%), and vascular murmur (8%). TRAS+ patients had significantly more cardiovascular risk factors and aorto-iliac vascular calcifications than in C1 group (58 vs 17%, p=0,002 and 71 vs 23% p<0,001, respectively). Compared to C2 patients, hypertension before transplantation was more common in TRAS+ (58 vs 10%, p<0,001).Warm ischemia time was also was longer in TRAS+ (100 min, range 69-151) than in C2 group (47 min, range 32-30) (p<0,001). TRAS+ patients had a higher serum creatinine at 1 year post graft (168 ∝mol/L [126-201] vs 115 ∝mol/L [106-133], p=0,003 in C1 group and 106 ∝mol/L [88-133], p=0,003 in C2 group) and a lower graft survival. ATL was performed in 11 patients (52%, ATL+) and led to an improvement of their blood pressure and renal function in 6 (55%) and 7 (64%) cases, respectively. Among ATL- patients, 5 (38%) kept hypertension and 4 (31%) displayed a progression of the transplant dysfunction. Graft survival rate was better in ATL+ than in ATLpatients. Conclusions: TRAS is associated with pretransplant cardiovascular comorbidities and vascular calcifications, and has a deleterious impact on renal function and graft survival. Angioplasty seems to improve the transplant outcome.