Abstract: SA-PO1041
Delayed Graft Function Due to Proximal Iliac Artery Stenosis: A Diagnostic Pitfall Despite Patent Transplant Vasculature
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bhutta, Beenish Sohail, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Lee, Jean, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Constantinescu, Serban, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Raiyani, Henish K., Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Shackleford, Christopher G., Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Lee, Iris J., Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
Introduction
We report a case of delayed graft function (DGF) post kidney transplant requiring prolonged dialysis, due to unrecognized stenosis of the left external iliac artery (LEIA) proximal to the renal artery anastomosis. The presence of patent renal vasculature and flow on initial transplant ultrasound (US) delayed further vascular evaluation. This case highlights the diagnostic value of low resistive indices (RIs) on transplant Doppler US as an early indicator of upstream vascular compromise.
Case Description
A 70-year-old woman with end-stage renal disease due to diabetes and hypertension underwent a donation after circulatory death (DCD) kidney transplant with a Kidney Donor Profile Index (KDPI) of 65%. A single artery and vein were anastomosed to the left iliac vessels. Prolonged DGF lasted for two months. Our patient was treated with steroids after allograft biopsy showed acute tubular necrosis and Banff 1A cellular rejection. However biopsy findings did not account for the severity of DGF. Notably, the mate kidney from the same donor recovered function and did not require ongoing dialysis.
Despite treatment of rejection and reassuring transplant US findings indicating patent vasculature, the patient remained dialysis dependent. Follow-up US revealed a drop in RI, prompting further evaluation with magnetic resonance angiography, which demonstrated severe stenosis of the LEIA just proximal to the renal artery anastomosis, secondary to atherosclerotic plaques and a short segment dissection with an intimal flap. Patient underwent percutaneous transluminal catheter guided stenting of the LEIA, resulting in a drop in pressure gradient from 80% to 0% post stent, leading to an improvement in renal function and discontinuation of dialysis.
Discussion
Significant upstream vascular lesions can be missed if diagnostic reliance is placed solely on the patency and flow characteristics of the transplant renal artery. Persistent DGF with unexplained etiology, particularly when RIs are low, should raise suspicion for proximal vascular pathology. Timely identification and correction of the LEIA stenosis led to dramatic improvement in graft function, underscoring the importance of comprehensive vascular assessment in cases of unexplained prolonged DGF.