Manejo endovascular de la estenosis de la arteria renal en el trasplante renal

INTRODUCTION: Transplant renal artery stenosis is a recognized complication of kidney transplantation associated with allograft dysfunction and even graft loss. It is a commonly missed but potentially treatable complication that may present from months to years after transplant surgery.  Its prompt diagnosis and adequate therapeutic management are essential to avoid renal function loss. MATERIAL AND METHODS: We retrospectively analysed the data from two 72-year-old patients transplanted in 2017 at our institution. Both with arterial hypertension, chronic ischemic heart disease and end-stage renal disease due to nephroangiosclerosis and membranous glomerulonephritis, respectively; presented allograft dysfunction in the immediate postoperative period. With this finding and the evidence of peak systolic velocity of >200 cm/s in the transplant renal artery we suspected transplant renal artery stenosis, confirmed by angiography and CT scan. An endovascular management with stent placement was performed. RESULTS: Both patients were managed by percutaneous transluminal renal angioplasty and stent placement with good morphological outcomes. After the procedure both patients presented a progressive renal function improvement, being discharged after 8 and 11 days, respectively. Since then, both patients have remained with stable renal function, presenting a glomerular filtration rate of 67 mL/min/1.73m2 and 60 mL/min/1.73m2 12 months after the surgery. No complications have been noticed after 14 months. CONCLUSION: Percutaneous transluminal renal angioplasty and stent placement is an effective and safe technique. Nevertheless, high experience is mandatory to reduce the number of complications and optimize the results of this technique.   Key words: kidney transplant, arterial stenosis, minimally invasive, endovascular surgery.