Role of 3D CT-angiography in Detecting Transplant Renal Artery Stenosis / 대한이식학회지

ABSTRACT

PURPOSE: Transplant renal artery stenosis (TRAS) is a potentially treatable complication of kidney transplantation. Color doppler ultrasound (doppler US) is recommended as primary diagnostic method, but it has some limitations. METHODS: We analyzed with 3D computed tomography angiography (3D-CTA) compared doppler US in the diagnosis of TRAS. Eleven transplant recipients (4 women, 7 men) with new developed or uncontrolled hypertension underwent 3D-CTA. We compared 3D-CTA with the dopper US in all TRAS recipients diagnosed 3D-CTA (n=6). RESULTS: The median age at transplantation was 42 year (Range 27~55 year), mean systolic blood pressure +/-SD was 163+/-9.9 mmHg and median HLA mismatch was 2 (0~4). The 3D-CTA showed significant TRAS (>70% luminal narrowing) in six recipients. Most commonly stenosis occurred at the anastomotic site (anastomic site, 4; pre-anastomotic 1; diffuse 1 recipients). The dopper US showed suspected TRAS in four recipients but no evidence of TRAS in two recipients. But these all patients showed significant stenosis (>70% luminal narrowing) of transplant renal artery by the percutaneous angiography. All six TRAS recipients successfully were treated by primary percutaneous angioplasty and endovascular stenting. Arterial blood pressure showed significantly improvement after post-endovascualr therapy (Presystolic, 170+/-8 mmHg; postsystolic, 151+/-16 mmHg; P=0.012 and prediastolic, 104+/-4; postdiastolic 92+/-8; P=0.007). CONCLUSION: The 3D-CTA is highly accurate and noninvasive screening test for detecting TRAS than dopper US.