Abstract: PO2566
Renal Transplant Artery Stenosis and Kinking: An Unusual Association
Session Information
- Transplant Complications: Glomerular Disease and Genetics
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Sosa Barrios, Haridian, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Burguera, Victor, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Casillas, Ester, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Villa, Daniel Eduardo, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Jimenez Alvaro, Sara, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Martin Capon, Irene, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Fernandez-Lucas, Milagros, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
- Rivera, Maite, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
Introduction
Renal artery stenosis of the kidney graft associated with kinking is not a frequent finding. As a correctable cause of graft dysfunction it is important to diagnose it as soon as possible to avoid further graft damage.
Case Description
A 62 year-old woman with ESRD due to ADPKD had a deceased donor kidney transplant (KTx) in her right iliac fossa (1 vein/1 artery) anastomosed to external iliac vessels. Immunosuppression:basiliximab, tacrolimus, everolimus and steroids. Creatinine drop halted 2 weeks post-op. Blood pressure was normal, CMV load : undetectable. Tacrolimus level:7-9 ng/ml. A KTx US was done, showing high velocities within KTx renal artery close to the anastomosis, increasing near a kinking image adjacent to the hilum (image 1), not present on Doppler US 1 day post-op.A CT angiography confirmed renal artery stenosis at anastomosis level and kinking of the graft renal artery (image 2). Endovascular angioplasty of the stenotic area without stenting was performed, but unsuccessful. Open surgery vascular reconstruction was carried out a week after angioplasty: renal artery was shortened and reimplanted. Within a week, graft function improved and Doppler US was normal.
Discussion
Renal artery stenosis is a correctable cause of hypertension and graft dysfunction in KTx. Graft renal artery kinking is rare, even more in association with stenosis, worsening its prognosis as kinking renders angioplasty less effective.
Complete Doppler US mapping of the graft’s arteries is essential to make an early diagnosis and nephrologists could do this examination promptly.