Long-term Graft and Patient Survival after Percutaneous Angioplasty or Arterial Stent Placement for Transplant Renal Artery Stenosis: A 21-year Matched Cohort Study.

Purpose To compare long-term graft and patient survival after percutaneous angioplasty (PTA) or stent placement for transplant renal artery stenosis (TRAS) with a control cohort without TRAS. Materials and Methods This is a retrospective matched cohort study of 41 patients (median age, 49 years; range, 18-72 years), including 27 male patients (median age, 48 years; range, 18-67 years) and 14 female patients (median age, 52 years; range, 24-68 years), with TRAS from December 1995 through 2016. Primary end points were death-censored graft and patient survival, compared by using log-rank test and Cox proportional regression. Secondary outcomes were improvement in renal function, blood pressure (BP), and complications. Results Twenty-four patients underwent PTA and 17 received stent placements. Ten-year graft survival was 92.1% (range, 83.2%-100%) versus 81.4% (range, 67.8%-95.3%) (P = .56), and 10-year patient survival was 89.9% (79.1%-100%) versus 84.7% (72.1%-97.5%) (P = .49), for the study and control groups, respectively. Five patients (12%) resumed dialysis in each group and a total of 17 patients died (eight in the study group and nine in the control group). Most patients died with a functioning graft (seven of eight in the study group and seven of nine in the control group). Posttreatment median systolic and diastolic BP improved by 12% and 7.4%, respectively, and serum creatinine improved by 27%. Normal systolic BP and serum creatinine level at 1 year after treatment were associated with better survival for patients (P = .04; hazard ratio [HR], 1.04; 95% confidence interval [CI]: 1.0, 1.075) and grafts (P < .001; HR, 1.02; 95% CI: 1.0, 1.027). Other covariates, including PTA versus renal stent placement, intra-arterial pressure gradient greater than 10%, diastolic BP, age at transplantation, sex, graft type, rejection, and delayed graft function, were not significant. Five patients (12.2%) had a complication (Society of Interventional Radiology class A, two of 41 [4.9%]; class B, two of 41 [4.9%]; and class D, one of 41 [2.4%]); 30-day graft loss and patient mortality were zero. Conclusion Long-term graft and patient survival after endovascular correction of transplant renal artery stenosis (TRAS) was similar to that without TRAS and most patients avoided returning to dialysis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Dickey and Durrani in this issue.