Percutaneous Endovascular Intervention in Transplant Renal Artery Stenosis: Long-term Outcome in the Chinese Population

Objective. To assess the technical success and long-term outcome in Chinese patients with transplant renal artery stenosis (TRAS) after percutaneous transluminal angioplasty (PTA), with or without stenting. Methods. A retrospective review of 44 consecutive PTA (with or without stenting) in 35 patients with TRAS from September 2003 to January 2012 in two regional hospitals of the New Territories East Cluster, Hong Kong was conducted. Technical success, complications, serum creatinine level, arterial blood pressure, and number of antihypertensive medications taken before and after intervention were assessed and compared. Graft survival was estimated using Kaplan-Meier method. Result. Of 44 interventions (17 PTA and 27 PTA with stenting) performed, 35 were primary interventions and the remaining 9 were secondary for re-stenosis. Overall technical success rate was 95.5% (PTA: 88.2%; PTA with stenting: 100%). No major complication or graft loss during intervention was observed. There were four minor complications including a self-limiting dissection in external iliac artery and three puncture site haematomas. There was no significant difference in restenosis rate between the PTA (25.0%) and PTA with stenting (26.1%) groups (p > 0.05). There was a persistent improvement in graft dysfunction and hypertensive control in the short and intermediate term, with satisfactory clinical success in patients presenting with graft dysfunction (100%) and hypertension (94%). Long-term clinical success in hypertensive control was relatively sustained (84.6%) while that in creatinine level it was only partially sustained (68.5%) with a mean follow-up of 70.3 (standard deviation, 32.9) months. Estimated allograft survival after all interventions was 100% at 1 year and 97% at 5 years. Conclusion. Treatment of haemodynamically significant TRAS with percutaneous endovascular intervention is a safe procedure with high technical success, showing beneficial effects in improving allograft function and blood pressure in the short and intermediate term, as well as good long-term graft survival.