Abstract: TH-PO938
Allograft Rescued from Pseudo Transplant Renal Artery Stenosis
Session Information
- Transplantation: AKI, Cardiovascular, and Metabolic Complications
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Garg, Gunjan, University of Michigan, Ann Arbor, Michigan, United States
- Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
- Samaniego-Picota, Milagros D., University of Michigan, Ann Arbor, Michigan, United States
Background
Transplant renal artery stenosis (TRAS) is a common vascular complication typically occurring 3-24mos post-transplant and may be due to surgical technique or size discrepancy between donor and recipient arteries. As the transplant population ages, there is increasing recognition of pseudo-transplant renal artery stenosis, in which vascular disease proximal to the arterial anastomosis results in graft failure. Here we present a rare case of late acute allograft failure secondary to pseudo-TRAS.
Methods
A 53 yo woman with diabetes, hypertension, smoking, without known peripheral vascular disease, who underwent a living unrelated kidney transplant 5yrs ago for PKD, presented with 4 days of graft tenderness and decreased urine output. Physical exam showed BP of 183/94 and tenderness over the left lower quadrant allograft. UA was negative for blood, protein or leukocytes. Serum Creatinine was 7.1 mg/dL (baseline 1.2 mg/dL). She reported compliance with immunosuppressants. A transplant ultrasound with Doppler showed 11.4cm kidney without hydronephrosis, although a parvus tardus waveform (Fig) was seen in the transplant renal artery with low resistive indices. A CO2 angiogram showed complete left common iliac (CIA) and proximal external iliac artery (EIA) occlusion with almost no flow to the transplant renal artery. Left CIA was stented with improved flow to the graft without any pressure gradient. Within 72 hrs, creatinine was 1.8 mg/dL and 1.2 mg/dL in 2 wks.
Conclusion
TRAS is a potentially reversible cause of graft dysfunction in early post transplant period, but patients with CVD risk factors can develop pseudo-TRAS in the iliac vessels as a late complication. Early detection can prevent complete graft loss. Transplant renal artery Doppler can show parvus tardus waveform, prolonged systolic acceleration with small amplitudes and blunting of the systolic peak suggesting poor arterial inflow to the kidney. Prompt intervention within 24 hrs of initial presentation, in our case, successfully rescued the allograft.
A.Parvus tardus waveform B.Aortoiliac angiogram showing complete occlusion of left CIA C.Post intervention angiogram