Renal artery stenosis after renal transplantation: the impact of the hypogastric artery anastomosis.

A review of 402 renal allotransplants performed during a 5-year period revealed 25 cases of transplant renal artery stenosis in 377 evaluable patients. To our knowledge this is the first large study of this transplant complication in which all patients received cyclosporine immunotherapy. The incidence of transplant renal artery stenosis was 6.6%. The mean internal from transplantation to onset of transplant renal artery stenosis was 11 months. No significant differences in atherosclerotic risk factors were detected between the groups with and without transplant renal artery stenosis. The incidence of acute allograft rejection was not increased in the stenosis group. There was no difference in the incidence of transplant renal artery stenosis following end-to-end (hypogastric artery) or end-to-side (common or external iliac artery) arterial anastomoses. Among patients having end-to-end hypogastric artery anastomoses the incidence of transplant renal artery stenosis was significantly greater (p < 0.01) when endarterectomy was required to render the hypogastric artery suitable for use. Percutaneous transluminal angioplasty was performed in 20 patients and open repair was performed in 18. After percutaneous transluminal angioplasty of hypogastric artery anastomoses, more additional procedures were required and there was a higher allograft loss rate when compared to percutaneous transluminal angioplasty of the external iliac artery. These data suggest that treatment of transplant renal artery stenosis in patients with end-to-end hypogastric artery anastomosis is more difficult and results in a higher morbidity rate than treatment in the external iliac artery group.