Abstract: SA-PO1212
A Case of Suboptimal Kidney Graft Function and the Role of Upstream Flow in Graft Function Improvement and Longevity
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
- Sardarli, Kamil, New York University Grossman School of Medicine, New York, New York, United States
- Hysi, Katerina, New York University Grossman School of Medicine, New York, New York, United States
Introduction
Peripheral vascular disease (PVD) is a significant risk factor for impaired renal allograft function and survival. Despite advances in vascular imaging, complex recipient vascular anatomy may remain underrecognized and contribute to post-transplant graft dysfunction. Although suboptimal graft function is commonly attributed to acute tubular injury (ATI) or rejection, proximal iliac inflow disease should also be considered in patients with diffuse PVD and persistent allograft hypoperfusion.
Case Description
A 68-year-old male with chronic kidney disease stage IV secondary to hypertension and type 2 diabetes mellitus and PVD with prior superficial femoral artery stenting underwent deceased donor kidney transplantation with thymoglobulin induction.
Post-transplant course was complicated by suboptimal allograft function with creatinine increasing to 5.45 mg/dL. Donor terminal creatinine was 1 mg/dL, and preimplantation biopsy showed mild vascular disease, minimal IF/TA, and 7% glomerulosclerosis.
Due to persistent allograft dysfunction, serial kidney biopsies were performed post-transplant and were limited by subcapsular sampling, demonstrating severe IF/TA. A third biopsy at 3 months post-transplant showed ATI and severe IF/TA.
MRA demonstrated a nonvisualized 0.5 cm segment of the mid transplant renal artery suspicious for stenosis and moderate-to-severe left common iliac artery (CIA) stenosis with post-stenotic dilatation. The transplant renal artery anastomosis remained patent.
The patient subsequently underwent CO2 angiography with successful angioplasty and stenting of the left CIA. Selective catheterization of the transplant renal artery was performed; however, the long-segment transplant renal artery stenosis could not be crossed for intervention.
Following iliac artery revascularization, blood pressure control improved, creatinine decreased to 3.13 mg/dL, and proteinuria improved. Further vascular intervention was deferred following multidisciplinary review.
Discussion
This case highlights the importance of evaluating proximal arterial inflow disease in kidney transplant recipients with resistant hypertension and allograft dysfunction. In patients with diffuse atherosclerotic disease, correction of iliac artery stenosis may significantly improve renal allograft perfusion and clinical outcomes even when direct intervention on transplant renal artery stenosis is unsuccessful.