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Renal transplant vascular complications and their impact on transplant failure and dialysis
Alison O. Flentje, BS, Sadaf S. Ahanchi, MD, Reynold Lopez-Soler, MD PhD, Dave J. Dexter, MD, John Colonna, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
Objectives: Renal transplant related vascular complications (RTVC), include transplant renal artery stenosis (TRAS), native iliac artery stenosis (NIAS), native iliac artery dissection (NIAD), and transplant renal vein stenosis (TRVS). RTVC is uncommon, but can still result in transplant dysfunction leading to end stage renal disease (ESRD) and return to dialysis. Our aim was to investigate the impact of RTVC on transplant function and return to dialysis.
Methods: A retrospective chart review was conducted on 327 consecutive patients who underwent renal transplant at a single institution from 2008 to 2012. Primary endpoints were loss of transplant function and return to dialysis. Secondary endpoint was survival. Chi squared analysis was done to compare patents with RTVC to those without RTVC.
Results:
Of the 327 patients reviewed 7 were excluded from the study (4 for lack of data, 1 for bilateral renal transplantation, 1 for hyperacute rejection, and 1 for immediate postoperative thrombosis of the graft). The overall patient cohort had a mean age of 50 with 55% males and an average BMI of 30. Comorbidities included smoking (30%), diabetes type 1 (6%), diabetes type 2 (46%), hypertension (98%), obesity (50%), hyperlipidemia (58%), coronary artery disease (33%), peripheral artery disease (11%), congestive heart failure (14%), and previous transplant (10%).
RTVC were diagnosed based on post transplant duplex ultrasounds. The RTVC of stenosis were defined as either a >50% luminal narrowing seen on 2D imaging, a peak systolic velocity (PSV) > 300 cm/sec, or a doubling of PSV between adjacent segments. Of the 320 patients, 37 were identified as having RTVC by duplex ultrasound: 16 with TRAS, 9 with NIAS, 2 with NIAD, and 10 with TRVS, while 283 had no evidence of RTVC. The rate of return to dialysis for the RTVC group was 22% in an average of 9 months, which was dramatically higher than the remaining patients without RTVC, which had a rate of return to dialysis of 12% in an average of 26 months, p= 0.03. At a mean follow up of 2.5 years, the overall mortality rate was 9%, with no difference between groups.
Conclusion: Patients with renal transplant vascular complications (RTVC) have a higher rate of post transplant graft dysfunction causing ESRD and return to dialysis when compared to patients without RTVC.
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