Interventional radiologic management for early post-transplant perfusion failure of renal allografts

Purpose: Open surgery for correction of early vascular complications in allogenic kidney transplantation carries the risk for increased morbidity and graft loss. The question was raised whether modern interventional radiologic techniques, especially the use of vascular stents, could play an alternative therapeutic role in those complicated cases. Material and Methods: 3 patients with early postoperative perfusion failure of their renal grafts were referred to the radiologist after Doppler sonography. Immediate digital subtraction angiography was initiated and during the same session percutaneous transluminal angiography and placement of a vascular stent were performed to treat the vascular lesion. Anticoagulation was started with low-dose aspirin 100 mg/day. Results: In all 3 patients an intimal dissection of the renal artery with formation of a relevant stenosis was found. Stenosis was corrected by angioplasty and stenting. In one case an accidentally found renal vein thrombosis was additionally treated by transcatheter thromboaspiration. No complications related to the interventions occurred. In 2 patients diuresis returned immediately and renal function remained stable in the longterm (follow-up 6 month). In one case massive peripheral arterial thrombosis had to be diagnosed in spite of successful recanalization of the renal artery. After explantation of the organ histology revealed extended parenchymal necrosis. Conclusions: The timely use of angiography after Doppler sonographic diagnosis for renal transplant perfusion failure is of help not only for exact diagnosis but also for immediate treatment. Radiologic interventional techniques should be regarded as potentially effective and safe for the treatment of early vascular complications after renal transplantation.