Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease

• Published in: Clinical transplantation 1999-08, Vol.13 (4), p.349-355
• Main Authors: Becker, Bryan N, Odorico, Jon S, Becker, Yolanda T, Leverson, Glen, McDermott, John C, Grist, Tom, Sproat, Ian, Heisey, Dennis M, Collins, Bradley H, D'alessandro, Anthony M, Knechtle, Stuart J, Pirsch, John D, Sollinger, Hans W
• Format: Article
• Language: English
• Subjects: Adult; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - etiology; Biological and medical sciences; Female; Humans; hypertension; Hypertension, Renovascular - etiology; Iliac Artery; iliac artery stenosis; kidney transplantation; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - etiology; Renal Artery Obstruction - etiology; renal artery stenosis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1034/j.1399-0012.1999.130412.x

Background: Renal transplant artery stenosis (RTAS) continues to be a problematic, but potentially correctable, cause of post‐transplant hypertension and graft dysfunction. Older transplant recipients, prone to peripheral vascular disease (PVD), may have pseudoRTAS with PVD involving their iliac system.Methods: We retrospectively analyzed 819 patients who underwent kidney transplantation between 1993 and 1997 to determine the contribution of pseudoRTAS to renal transplant renovascular disease. Univariate analyses were performed for donor and recipient variables, including age, weight, gender, race, renal disease, cholesterol and creatinine values, human leukocyte antigen (HLA) matching, cytomegalovirus (CMV) infection, and immunosuppressive medications. Significant variables were then analyzed by a Cox proportional hazards model.Results: Ninety‐two patients (11.2%) underwent renal transplant arteriogram (Agram) or magnetic resonance angiography (MRA) for suspected RTAS. RTAS or pseudoRTAS, defined as one or more hemodynamically significant lesions in the transplant artery or iliac system, was evident in 44 patients (5.4%). Variables significantly associated with RTAS by univariate analysis were weight at the time of transplant (p=0.0258), male gender (p=0.034), discharge serum creatinine> 2 mg/dL (p=0.0041), and donor age (p=0.0062). Variables significantly associated with pseudoRTAS by univariate analysis were weight at the time of transplant (p=0.0285), recipient age (p=0.0049), insulin‐dependent diabetes mellitus (IDDM; p=0.0042), panel reactive antibody (PRA) at transplant (p=0.018), and body mass index (p=0.04). Weight at transplant and donor age remained significantly associated with an increased risk for RTAS in a multivariate stepwise Cox proportional hazards model. IDDM, transplant PRA, weight at transplant, and donor age were significantly associated with an increased risk for pseudoRTAS in a multivariate stepwise Cox proportional hazards model. Importantly, both RTAS and pseudoRTAS were associated with poorer graft survival (p