Journal List > J Korean Soc Transplant > v.30(2) > 1034484

Kim, Jung, Lee, Kim, Lee, Oh, Kim, Sin, Kim, Huh, Park, and Jung: Successful Balloon Angioplasty with Low-pressure Balloon on Early Transplant Renal Artery Stenosis at Postoperative Day 7

Abstract

Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft's renal artery and the patient's common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90∼ 180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient's common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient's common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.

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Fig. 1.
Magnetic resonance renal angiography of the transplanted kidney. Note that focal stenosis at anastomotic site between transplanted renal artery and right common iliac artery.
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Fig. 2.
Renal angiogram of the transplanted renal artery. Pressure gradient between right common iliac artery and transplanted renal artery was checked.
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Fig. 3.
Angioplasty with low pressure balloon.
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Fig. 4.
Pressure gradient after angioplasty.
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Fig. 5.
Clinical course, creatinine level, and estimated glomerular filtration rate (eGFR). Abbreviations: PTA, percutaneous transluminal angioplasty; CG, cockcroft-gault equation; MDRD, Modification of Diet in Renal Disease.
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Fig. 6.
Clinical course, blood pressure alteration after percutaneous transluminal angioplasty (PTA). Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial pressure.
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