Renal Artery Stenosis in Transplant Patients

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Abstract
Although hypertension appears not infrequently among recipients of kidney transplants, renal artery stenosis is relatively rare as a causative factor. A 23-yr experience of patients receiving kidney grafts at the Brigham and Women''s Hospital [Boston, Massachusetts, USA] was reviewed to ascertain the incidence of renal artery stenosis and its surgical management. Risk factors leading to the condition and selection of patients for operation are emphasized. The incidence of arterial stenosis severe enough to require operation was 2.7% of 914 kidney transplants; the overall incidence in these patients is unknown, although operated patients comprise about 1/2 of those undergoing arteriography to diagnose hypertension. The mean time for development of the condition was 21.4 mo. from date of engraftment. A successful outcome as measured by fall in blood pressure and/or serum creatinine was achieved in 14 of 21 patients (67%) in whom surgical repair of the effected artery was undertaken. Reparative surgery was unsuccessful in 7 patients, although hypertension was improved in 1 of these individuals following transplant nephrectomy. Surgery was never undertaken in 4 patients because of chronic rejection noted on biopsy. There was no mortality. Operative repair should be offered to patients with rneal artery stenosis leading to unmanageable hypertension or renal dysfunction, but withheld from those with documented chronic rejection regardless of major arterial compromise.