American Journal of Nephrology
Original Report: Patient-Oriented, Translational Research
Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDSHurst F.P.a · Abbott K.C.a · Neff R.T.a · Elster E.A.b · Falta E.M.b · Lentine K.L.c · Agodoa L.Y.d · Jindal R.M.bDepartments of aNephrology and bSurgery, Walter Reed AMC, Washington, D.C., cCenter for Outcomes Research, St. Louis University School of Medicine, St. Louis, Mo., dNational Institute of Diabetes, Digestive and Kidney Disorders, National Institutes of Health, Bethesda, Md., USA
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Article / Publication Details
Received: July 31, 2009
Accepted: August 20, 2009
Published online: September 24, 2009
Issue release date: November 2009
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
Abstract
Objective: We analyzed the United States Renal Data System registry to study the risks, predictors, and outcomes of transplant renal artery stenosis (TRAS) in contemporary practice. Methods: The study sampled comprised adults with Medicare primary insurance who received kidney transplants in 2000–2005. We examined associations of recipient, donor and transplant factors with time-to-TRAS by the Kaplan-Meier method and multivariate Cox regression. Survival analysis methods were employed to estimate graft survival after TRAS, and to model TRAS as a time-dependent outcome predictor. Kaplan-Meier analysis was used to estimate time to allograft loss in patients who did or did not have an angioplasty procedure for TRAS. Results: There were 823 cases of TRAS among 41,867 transplant patients, with an incidence rate of 8.3 (95% CI 7.8–8.9) cases per 1,000 patient-years. Mean time to diagnosis of TRAS was 0.83 ± 0.81 years after transplant. Factors associated with TRAS were older recipient and donor age, extended criteria donors, induction immunosuppression, delayed graft function, and ischemic heart disease. There was no association of TRAS with deceased donors, prolonged cold ischemia time, acute rejection or cytomegalovirus status. TRAS was associated with increased risk of graft loss (including death; adjusted hazard ratio 2.84, 95% CI 1.70–4.72). Among the 823 patients with TRAS, 145 (17.6%) underwent angioplasty. Graft survival after TRAS was not significantly different in patients treated with angioplasty compared to those without angioplasty. Conclusions: TRAS is an important complication that predicts adverse patient and graft outcomes. Treatment strategies for TRAS warrant prospective investigation in clinical trials.
© 2009 S. Karger AG, Basel
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References
- Bruno S, Remuzzi G, Ruggenenti P: Transplant renal artery stenosis. J Am Soc Nephrol 2004;15:134–141.
- Patel NH, Jindal RM, Wilkin T, et al: Renal artery stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology 2001;219:663–667.
- Wong W, Fynn SP, Higgins RM, et al: Transplant renal artery stenosis in 77 patients: does it have an immunological cause? Transplantation 1996;61:215–219.
- Audard V, Matignon M, Hemery F, et al: Risk factors and long-term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant 2006;6:95–99.
- Geddes CC, McManus SK, Koteeswaran S, Baxter GM: Long-term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention. Clin Transplant 2008;22:572–578.
-
How good are the data? USRDS data validation special study. Am J Kidney Dis 1992;20(suppl 2):68–83.
- Krumme B, Pisarski P, Blum U, Kirste G, Schollmeyer P: Unusual cause of early graft dysfunction after kidney transplantation. Am J Nephrol 1998;18:237–239.
- Morris PJ, Yadav RV, Kincaid-Smith P, et al: Renal artery stenosis in renal transplantation. Med J Aust 1971;1:1255–1257.
- Halimi JM, Al-Najjar A, Buchler M, et al: Transplant renal artery stenosis: potential role of ischemia/reperfusion injury and long-term outcome following angioplasty. J Urol 1999;161:28–32.
- Johnston TD, Thacker LR, Jeon H, Lucas BA, Ranjan D: Sensitivity of expanded-criteria donor kidneys to cold ischaemia time. Clin Transplant 2004;18(suppl 12):28–32.
- Hassanain M, Tchervenkov J, Cantarovich M, et al: Delayed graft function has an equally bad impact on deceased donor renal graft survival in both standard criteria donors and expanded criteria donors. Transplant Proc 2009;41:133–134.
- Macia M, Paez A, Tornero F, De Oleo P, Hidalgo L, Barrientos A: Post-transplant renal artery stenosis: a possible immunological phenomenon. J Urol 1991;145:251–252.
-
Humar A, Uknis M, Papalois V, Gillingham K, Matas A: Is there an association between cytomegalovirus and renal artery stenosis in kidney transplant recipients? Transplantation 2000;69:S386.
External Resources
- Benoit G, Moukarzel M, Hiesse C, Verdelli G, Charpentier B, Fries D: Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty. Transplant Int 1990;3:137–140.
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Balzer KM, Pfeiffer T, Rossbach S, et al: Prospective randomized trial of operative vs interventional treatment for renal artery ostial occlusive disease (RAOOD). Vasc Surg 2009;49:667–674.
External Resources
- Douis H, Shabir S, Lipkin G, Riley P: Drug-eluting stent insertion in the treatment of in-stent renal artery restenosis in three renal transplant recipients. J Vasc Interv Radiol 2008;19:1757–1760.
Article / Publication Details
Received: July 31, 2009
Accepted: August 20, 2009
Published online: September 24, 2009
Issue release date: November 2009
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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