Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 152660282110385
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Gustavo Salgado-Garza ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Luis Carlos Bueno-Gutierrez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Serum Creatinine Level ◽  
Endovascular Treatment ◽  
Renal Artery Stenosis ◽  
Creatinine Level ◽  
Mean Difference ◽  
Artery Stenosis

Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

Predictors for Clinical Success at One Year following Renal Artery Stent Placement

2002 ◽  
Vol 9 (4) ◽  
pp. 495-502 ◽  
Author(s):  
Trude C. Gill-Leertouwer ◽  
Elma J. Gussenhoven ◽  
Johanna L. Bosch ◽  
Jaap Deinum ◽  
Hans van Overhagen ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Artery Stenosis ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

Endovascular Treatment versus Medical Therapy for Hypertensive Patients with Renal Artery Stenosis: An Updated Systematic Review

2019 ◽  
Vol 61 ◽  
pp. 445-454
Author(s):  
Davide Piaggio ◽  
Umberto Bracale ◽  
Leandro Pecchia ◽  
Maria Donata Di Taranto ◽  
Maurizio Sodo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Artery ◽  
Endovascular Treatment ◽  
Renal Artery Stenosis ◽  
Medical Therapy ◽  
Artery Stenosis ◽  
Hypertensive Patients

scholarly journals Clinical response scores to predict blood pressure and renal function improvement following renal artery stenting for atherosclerotic renal artery stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kablak-Ziembicka ◽  
A Roslawiecka ◽  
R Badacz ◽  
A Sokolowski ◽  
P Musialek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Predictive Models ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Baseline Serum ◽  
Kidney Length

Abstract Background It is little known about predictors of systolic (SBP) and diastolic (DBP) blood pressure or renal function (eGFR) improvement in patients with atherosclerotic renal artery stenosis (ARAS) undergoing stent-assisted angioplasty (PTA). Therefore, we aimed to build a prediction scores that would indicate characteristics of patient subsets with ARAS most likely to have clinical improvement following PTA. Methods 201 patients who underwent PTA for ARAS (2003–2018) were categorized as eGFR or SBP/DBP responders based on eGFR increase of ≥11 ml/min/1.73m2, decrease of SBP ≥20mmHg and DBP ≥5mmHg at 12-months following PTA. The remaining patients were classified as non-responders. The performance of logistic regression models were evaluated by basic decision characteristics. Continuous data have been transformed into binary coding with help of operating characteristic (ROC) curve. Predictive models have been constructed for each followed by construction of predictive models in each of 3 categories. Results Logistic regression analysis showed that: baseline SBP&gt;145 mmHg, DBP &gt;82 mmHg, previous myocardial infarction and Renal-Aotric-Ratio &gt;5.1 were independent influencing factors of SBP response, with relative risk percentage shares of 69.8%; 12.1%; 10.9%; and 7.2%, respectively (sensitivity: 82%, specificity: 86.3%, positive (PPV):82% and negative (NPV) predictive values: 86.3%). The DBP decrease prediction model included baseline SBP &gt;145 mmHg and DBP &gt;82 mmHg, the ARAS progression, index kidney length &gt;106 mm, and bilateral PTA with respective shares of 35.0%; 21.8%; 18.2%; 13.3% and 11.8%. (sensitivity: 76%, specificity: 77.8%, PPV: 80.7% and NPV: 72.6%). The eGFR increase was associated with baseline serum creatinine &gt;122 μmol/L but eGFR greater than 30 ml/min/1.73m2, index kidney length &gt;98 mm, end-diastolic velocity in index renal artery, renal resistive index &lt;0.74, and requirement for &gt;3 BP medications, with respective shares of 24.4%; 24.4%; 21.2%; 15% and 15% (sensitivity: 33.3%, specificity: 93.5%, PPV: 65.6% and NPV: 78.9%). Conclusions Current study identified clinical characteristics of patients who most likely to respond to PTA for ARAS. The sutability of the score should be verified in a prospective cohort of patients referred to PTA of ARAS Funding Acknowledgement Type of funding source: None

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