Abstract: SA-PO1203
When Revascularization Isn't the Whole Story: Lessons from Transplant Renal Artery Stenosis
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Agarwal, Krishna A., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Maturostrakul, Boonyanuth N., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Barbash, Daniel, Baystate Medical Center, Springfield, Massachusetts, United States
- McPartland, Kenneth J., Baystate Medical Center, Springfield, Massachusetts, United States
Introduction
Transplant renal artery stenosis (TRAS) is the most common vascular complication after kidney transplantation (KT), reported in up to 23% of recipients. Causes include technical factors, atherosclerosis, immunologic injury, and external compression. It typically presents within 3–6 months with refractory hypertension, allograft dysfunction, or volume overload. Duplex ultrasonography is the primary screening tool, with angiography as the gold standard. Management varies, though percutaneous transluminal angioplasty (PTA) ± stenting is first-line. We present a single-center experience of 13 cases.
Case Description
Only 54% of KTRs with TRAS had hemodynamic significance. Median time from KT to intervention was 4.7 months (range 1.7–15.8), with 77% occurring within 6 months. Mean serum creatinine improved from 3.5 to 2.61 mg/dL at 1 month, with 75% showing improvement (mean ↓ 0.72 mg/dL), and further to 2.48 mg/dL at 3 months, followed by relative stability. Longer-term outcomes were heterogeneous and often driven by non-vascular factors, including acute rejection and BK nephropathy. Procedural complications occurred in 38%, including vascular injury and pseudoaneurysm; one patient developed graft loss requiring dialysis.
Discussion
Endovascular treatment of TRAS is associated with early improvement in allograft function, even without clear hemodynamic significance. However, long-term outcomes appear driven more by concurrent allograft pathology than the vascular lesion itself. The relatively high complication rate highlights the need for careful patient selection and procedural planning. While PTA ± stenting provides short-term benefit, durable graft function depends on multifactorial processes beyond revascularization. Larger studies are needed to define optimal intervention triggers and predictors of sustained response.
Kidney transplant recipients with transplant renal artery stenosis