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. 2025 Mar 11;17(3):e80393.
doi: 10.7759/cureus.80393. eCollection 2025 Mar.

Diagnosis and Endovascular Management of Transplant Renal Artery Stenosis: A Retrospective Two-Decade Study

Brankica Spasojevic Dimitrijeva  1   2 , Milan Djukic  3   2 , Ivana Gojkovic  1 , Srdjan S Nikolovski  4 , Dragan Sagic  5   2 , Polina Pavicevic  6   2 , Tijana Radovic  6 , Dragan Vasic  7 , Oliver Radmili  7 , Igor Stefanovic  3   2 , Mirjana Kostic  1   2 , Mirjana Cvetkovic  1   2
Affiliations

Diagnosis and Endovascular Management of Transplant Renal Artery Stenosis: A Retrospective Two-Decade Study

Brankica Spasojevic Dimitrijeva et al. Cureus. .

Abstract

Introduction Transplant renal artery stenosis (TRAS) is a potentially treatable posttransplant complication, primarily presenting with arterial hypertension and allograft dysfunction. Its prevalence in children with posttransplant hypertension ranges from 5% to 15%. Diagnosis is typically made through invasive angiography following suspicion raised by echo Doppler findings. Treatment options include medical therapy, percutaneous transluminal angioplasty (PTA)/stenting, and surgical revascularization. This study aimed to assess the efficacy, complications, and outcomes of PTA/stenting procedures in children with TRAS. Methods We reviewed all pediatric patients who underwent renal transplantation in Serbia between June 2001 and February 2023 to identify cases of TRAS treated with PTA. Statistical analysis was performed to compare pre- and post-intervention arterial vessel diameters, serum creatinine levels, estimated glomerular filtration rate (eGFR), mean blood pressure, systolic and diastolic blood pressure indices, and the number of antihypertensive medications used. Results Seven patients underwent PTA with or without stent placement for TRAS. None were treated solely with medical therapy or surgical intervention. The overall prevalence of TRAS was 6.32%, higher in cadaveric transplants (11.11%) compared to living-related transplants (3.39%). Of the seven patients, five underwent PTA alone, while two required stent placement. Two of the five PTA patients required re-interventions, resulting in a total of seven angioplasty procedures. No complications occurred following the procedures. After a mean follow-up of 56.86 ± 45.76 months, patients demonstrated improved blood pressure control and reduced use of antihypertensive medications. While the mean eGFR showed a nonsignificant improvement, one patient with severe concomitant cytomegalovirus disease progressed to grade IV chronic kidney disease. Conclusions PTA, with or without stenting, appears to be an effective and safe treatment for TRAS in children, with immediate and intermediate-term results comparable to those reported in the literature. Stent placement may be particularly suitable for adolescents who have completed their growth phase.

Keywords: angioplasty; blood pressure; glomerular filtration rate; kidney transplantation; renal artery obstruction; stents.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University Children’s Hospital Ethics Committee issued approval 16/23. The project investigating genetic basis of human vascular and inflammatory diseases is approved. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Patient No. 2: Visible stenosis angiography finding before the PTA with stent placement
PTA, percutaneous transluminal angioplasty
Figure 2
Figure 2. Patient No. 2: Angiogram during the first stent placement
Figure 3
Figure 3. Patient No. 2: Angiogram during the second stent placement
Figure 4
Figure 4. Patient No. 2: Angiography finding after the PTA with stent placements
PTA, percutaneous transluminal angioplasty
Figure 5
Figure 5. Patient No. 7: Visible stenosis angiography finding before the PTA
PTA, percutaneous transluminal angioplasty
Figure 6
Figure 6. Patient No. 7: Angiogram during the balloon angioplasty
Figure 7
Figure 7. Patient No. 7: Angiography finding after the PTA
PTA, percutaneous transluminal angioplasty
Figure 8
Figure 8. MLD values before and after TRAS treatment (n = 7)
MLD, minimal lumen diameter; TRAS, transplant renal artery stenosis
Figure 9
Figure 9. SBPi before and after TRAS treatment (n = 7)
SBPi, systolic blood pressure index; TRAS, transplant renal artery stenosis
Figure 10
Figure 10. DBPi before and after TRAS treatment (n = 7)
DBPi, diastolic blood pressure index; TRAS, transplant renal artery stenosis
See this image and copyright information in PMC

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