Treatment of arterial stenosis of the kidney graft with transluminal angioplasty

OBJECTIVES: The present study was conducted to determine the prevalence of renal artery stenosis (RAS) after kidney transplantation (KT) in hypertensive patients, the efficacy of transluminal angioplasty in the treatment of hypertension secondary to RAS and the morbidity and mortality of angioplasty. METHODS: RAS was suspected in patients with hypertension refractory to medical treatment, with or without functional deterioration or murmur over the graft. Hypertension control, renal function and requirement of drugs were evaluated in 578 transplants performed from 1979 to 1994. RESULTS: The prevalence of hypertension post-transplantation was 43.8% (253/578): 14.2% (42/253) had arteriographically demonstrated RAS, accounting for 7.2% (42/578) of the series. Of these 42 patients, 23 (57%) received antihypertensive drugs: 13 (31%) were treated by angioplasty and 6 (12%) underwent surgical revascularization as the first approach. In the patients submitted to transluminal angioplasty, the stenosis was postanastomotic in 7 and anastomotic in 5: one patient was lost to follow-up. Angioplasty was successful in 8 patients and failed in 4. A graft was lost due to artery thrombosis. Complications were observed in 8 patients. There were no deaths and the incidence of RAS recurrence postangioplasty was 33% (4/12). CONCLUSIONS: RAS is a potentially reversible cause of hypertension post-transplantation. Transluminal angioplasty is the first approach in RAS when medical treatment has failed. The success rate of angioplasty was 66% and the incidence of RAS recurrence was 33%.