BACKGROUND: Transplant renal artery stenosis (TRAS) is an increasingly recognised cause of post-transplant hypertension. METHODS: We retrospectively analysed 216 paediatric renal recipients transplanted between 2001 and 2011 to assess TRAS prevalence and percutaneous transluminal angioplasty (PTA) efficacy. To assess risk factors, we compared children with TRAS with a propensity score-matched cohort of recipients without TRAS. RESULTS: Of the 216 paediatric patients who were transplanted in the study period, 44 were hypertensive (prevalence 20.3 %) and ten presented with TRAS (prevalence 4.6 %, median age at transplantation 14 years, range 6.78-17.36 years). Hypertensive patients without TRAS were prescribed one to two anti-hypertensive agents, whereas patients with TRAS required one to five medications. In the TRAS group, one recipient presented with vascular complications during surgery, and in three patients the graft had vascular abnormalities. TRAS was detected by Doppler ultrasonography (US) performed due to hypertension in nine of the patients with TRAS, but in the tenth case the TRAS was clinically silent and detected by routine Doppler-US screening. TRAS diagnosis was refined using angio-computed tomography or angio-magnetic resonance imaging. All patients underwent PTA without complications. Significant improvement after PTA was observed in the standard deviation scores for blood pressure [3.2 ± 1.4 (pre-PTA) vs. 1.04 ± 0.8 (post-PTA); p = 0.0006) and graft function [creatinine clearance: 69 ± 17.08 (pre-PTA) vs. 80.7 ± 21.5 ml/min/1.73 m(2) (post-PTA); p = 0.006] We observed no significant differences between the two cohorts for cold ischaemia time, recipient/donor weight ratio, delayed graft function, cytomegalovirus infections and acute rejection episodes. CONCLUSIONS: Our study reports a low but significant TRAS prevalence among the paediatric patients who were transplanted at our centre in the study period and confirms that PTA is an effective and safe therapeutic option in paediatric renal transplant recipients. Known risk factors do not appear to be related to the development of TRAS.
BACKGROUND:Transplant renal artery stenosis (TRAS) is an increasingly recognised cause of post-transplant hypertension. METHODS: We retrospectively analysed 216 paediatric renal recipients transplanted between 2001 and 2011 to assess TRAS prevalence and percutaneous transluminal angioplasty (PTA) efficacy. To assess risk factors, we compared children with TRAS with a propensity score-matched cohort of recipients without TRAS. RESULTS: Of the 216 paediatric patients who were transplanted in the study period, 44 were hypertensive (prevalence 20.3 %) and ten presented with TRAS (prevalence 4.6 %, median age at transplantation 14 years, range 6.78-17.36 years). Hypertensivepatients without TRAS were prescribed one to two anti-hypertensive agents, whereas patients with TRAS required one to five medications. In the TRAS group, one recipient presented with vascular complications during surgery, and in three patients the graft had vascular abnormalities. TRAS was detected by Doppler ultrasonography (US) performed due to hypertension in nine of the patients with TRAS, but in the tenth case the TRAS was clinically silent and detected by routine Doppler-US screening. TRAS diagnosis was refined using angio-computed tomography or angio-magnetic resonance imaging. All patients underwent PTA without complications. Significant improvement after PTA was observed in the standard deviation scores for blood pressure [3.2 ± 1.4 (pre-PTA) vs. 1.04 ± 0.8 (post-PTA); p = 0.0006) and graft function [creatinine clearance: 69 ± 17.08 (pre-PTA) vs. 80.7 ± 21.5 ml/min/1.73 m(2) (post-PTA); p = 0.006] We observed no significant differences between the two cohorts for cold ischaemia time, recipient/donor weight ratio, delayed graft function, cytomegalovirus infections and acute rejection episodes. CONCLUSIONS: Our study reports a low but significant TRAS prevalence among the paediatric patients who were transplanted at our centre in the study period and confirms that PTA is an effective and safe therapeutic option in paediatric renal transplant recipients. Known risk factors do not appear to be related to the development of TRAS.
Authors: V Audard; M Matignon; F Hemery; R Snanoudj; P Desgranges; M C Anglade; H Kobeiter; A Durrbach; B Charpentier; P Lang; P Grimbert Journal: Am J Transplant Date: 2006-01 Impact factor: 8.086
Authors: B Sis; M Mengel; M Haas; R B Colvin; P F Halloran; L C Racusen; K Solez; W M Baldwin; E R Bracamonte; V Broecker; F Cosio; A J Demetris; C Drachenberg; G Einecke; J Gloor; D Glotz; E Kraus; C Legendre; H Liapis; R B Mannon; B J Nankivell; V Nickeleit; J C Papadimitriou; P Randhawa; H Regele; K Renaudin; E R Rodriguez; D Seron; S Seshan; M Suthanthiran; B A Wasowska; A Zachary; A Zeevi Journal: Am J Transplant Date: 2010-01-29 Impact factor: 8.086
Authors: M Rengel; G Gomes-Da-Silva; L Incháustegui; J L Lampreave; R Robledo; A Echenagusia; J L Vallejo; F Valderrábano Journal: Kidney Int Suppl Date: 1998-12 Impact factor: 10.545
Authors: Luciana de Santis Feltran; Camila Penteado Genzani; Fernando Hamamoto; Mariana Janiques Barcia Magalhaes Fonseca; Maria Fernanda Carvalho de Camargo; Nara Léia Gelle de Oliveira; Fabio Cabral de Freitas Amaral; Jose Carlos Baptista; Paulo Cesar Koch Nogueira Journal: Pediatr Nephrol Date: 2021-10-14 Impact factor: 3.714
Authors: Leonardo G M Valle; Rafael N Cavalcante; Joaquim M Motta-Leal-Filho; Breno B Affonso; Francisco L Galastri; Marisa P Doher; Nadia K Guimarães-Souza; Ana K N Cavalcanti; Rodrigo G Garcia; Álvaro Pacheco-Silva; Felipe Nasser Journal: Clinics (Sao Paulo) Date: 2017-12 Impact factor: 2.365