Vascular Reconstruction of Multiple Renal Arteries-A Risk Factor for Transplant Renal Artery Stenosis: Insight From a Matched Case-Control Study

Transpl Int. 2024 Nov 7:37:13298. doi: 10.3389/ti.2024.13298. eCollection 2024.

Abstract

Transplant Renal Artery Stenosis (TRAS) is the leading vascular complication following kidney transplantation (KT), causing premature allograft loss and increased post-KT mortality. While risk factors for TRAS, such as prolonged cold ischemia time and delayed graft function, are well-documented in deceased donor-KT, the risk factors remain less clearly defined in living donor-KT. This matched case-control study, conducted at a leading national transplant center predominantly performing living donor-KT, evaluated risk factors and long-term outcomes of clinical TRAS (cTRAS). cTRAS cases diagnosed from January 2009 to December 2022 were matched with four control kidney transplant recipients (KTRs) in a study powered to assess whether ex-vivo arterial vascular reconstruction of multiple renal arteries (VR-MRA) increases the risk of cTRAS. Among 2,454 KTs, 28 KTRs (1.14%) were diagnosed with cTRAS around 3.62 ± 1.04 months post-KT, with renal allograft dysfunction (92.86%) as the most common presenting feature. Notably, 27 cTRAS cases were successfully treated with endovascular intervention, yielding favorable outcomes over a 6-180 months follow-up period. The study identified ex-vivo VR-MRA as an independent risk factor for cTRAS (P < 0.001). cTRAS cases receiving timely treatment exhibited long-term outcomes in graft and patient survival similar to control KTRs. Early screening and timely intervention for cTRAS post-KT may improve graft and patient outcomes.

Keywords: endovascular intervention; ex-vivo back-table reconstruction; multiple renal arteries; transplant renal artery stenosis; vascular reconstruction.

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Graft Survival
  • Humans
  • Kidney Transplantation* / adverse effects
  • Living Donors
  • Male
  • Middle Aged
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods
  • Postoperative Complications / etiology
  • Renal Artery Obstruction* / etiology
  • Renal Artery Obstruction* / surgery
  • Renal Artery*
  • Retrospective Studies
  • Risk Factors
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / methods

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.