ABSTRACT
Objective: renal artery stenosis [RAS] occurs in 0.4-12% of cases after kidney transplantation [KT]. The objective of this study is to report the incidence of RAS after KT in our experience, the presenting symptoms, and the modality of diagnosis, the types of treatment, and the outcomes
Methods: between October 1985 and December 2003, 501 KTs from living related donors [LRD] were performed at Al-Mouassat University Hospital, Damascus, Syria. Renal artery stenosis was diagnosed in six patients. All cases of RAS in this series were studied whether they were diagnosed by color Doppler, MRI, or arteriogram
Results: six cases of RAS out of 501 KTs has been diagnosed [1.2%]. The age of the patients at the time of diagnosis ranged between 27 and 60 years [mean 36.8]. There were 4 males and two females. The delay between the time of KT and diagnosis of RAS was from 2.5 to 24 months [mean 13.5]. The diagnosis was suspected clinically based on arterial hypertension and elevated blood creatinine in all cases, by color Doppler ultrasound in five cases, and by MRI in two cases. It was confirmed by selective arteriogram in 6 cases. Conservative treatment was applied to all patients. Transluminal angioplasty without stenting was performed in three cases. It was successful in two cases and complicated by renal artery rupture with subsequent kidney transplant resection in 1 case. Successful surgical treatment was applied in three patients. The follow-up ranged between two to 61 months [mean: 20.6]. All cases except one have a normal blood arterial pressure and normal blood creatinine level at discharge and on follow-up
Conclusion: RAS after KT should be suspected clinically in case of arterial hypertension resistant to medical treatment associated with elevated blood creatinine level. The color Doppler ultrasound is a very effective mean for diagnosis. Transluminal angioplasty is the treatment of choice and should be performed by experienced interventional radiologists. Surgical treatment in experienced hands has very good results