NYMC Faculty Publications

Safety and Efficacy of Drug Eluting Stents for Treatment of Transplant Renal Artery Stenosis

Heepeel Chang, Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.Follow
Bruce E. Gelb, Department of Surgery, Transplant Institute, New York University Langone Medical Center, New York, NY.
Zoe A. Stewart, Department of Surgery, Transplant Institute, New York University Langone Medical Center, New York, NY.
Bonnie E. Lonze, Department of Surgery, Transplant Institute, New York University Langone Medical Center, New York, NY.
Karan Garg, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
Caron B. Rockman, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
Glenn R. Jacobowitz, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
Thomas S. Maldonado, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
Jonathan C. Berger, Department of Surgery, Transplant Institute, New York University Langone Medical Center, New York, NY.
Nicole M. Ali, Department of Surgery, Transplant Institute, New York University Langone Medical Center, New York, NY.
Neal S. Cayne, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY. Electronic address: Neal.Cayne@nyulangone.org.

Author Type(s)

Faculty

DOI

10.1016/j.avsg.2022.03.033

Journal Title

Annals of Vascular Surgery

First Page

245

Last Page

253

Document Type

Article

Publication Date

11-1-2022

Department

Surgery

Abstract

BACKGROUND: Transplant renal artery stenosis (TRAS) after renal transplantation is a common cause of graft dysfunction and failure. Endovascular intervention in the form of percutaneous transluminal angioplasty (PTA) and stenting has rapidly become the dominant treatment modality for the TRAS. There is a paucity of clinical data on the use of drug-eluting stent (DES) for TRAS. We investigated the outcomes of patients with clinically significant TRAS undergoing DES placement. METHODS: A retrospective review of patients with clinically significant TRAS undergoing PTA with DES placement from June 2014 to April 2021 was conducted. Patients treated for TRAS exhibited uncontrolled hypertension and/or unexplained allograft dysfunction. Patient demographics, procedural details, and follow-up outcomes were collected. Primary endpoints were the in-stent primary patency and graft survival. Secondary endpoints were freedom from reintervention, primary-assisted patency, and access-related complications. RESULTS: Thirteen TRAS in 12 patients with graft function alteration were treated with DES. The median age was 57 years (interquartile range (IQR), 48-63 years), and 9 (70%) patients were male. The median follow-up was 9 months (IQR, 4-52 months). The most common comorbidity was hypertension (100%), coronary artery disease (83%), and diabetes. The median time from deceased donor transplant to intervention was 5.8 months (IQR, 3.5-6.7 months). TRAS was most commonly found at the juxta-ostial segment (77%). The procedure was performed with carbon dioxide angiography with minimal amount of iodinated contrast (median, 3 mL) under local anesthesia in 9 (69%), and general anesthesia in 4 (31%) patients. The median stent diameter was 4.5 mm (IQR, 4-5 mm), and the median stent length was 15 mm (IQR, 15-18 mm). No intraoperative complications occurred. The rates of stenosis-free primary patency of the DES and graft survival were 76% and 100%, respectively. All 3 reinterventions for restenosis resulted from the kinking of the transplant renal artery proximal to the DES, which were treated by extending the stent more proximally 1-2 mm into the external iliac artery. There were no access-related complications. The median time to reintervention was 0.9 months (range, 0.23-2 months). Freedom from reintervention and primary-assisted patency were 76% and 100%, respectively. CONCLUSIONS: Our study demonstrates that DES is a safe and effective treatment modality in patients with TRAS at short to mid-term follow-up. As all reinterventions after DES were performed due to kinking of the transplant renal artery proximal to the stent, bridging of the DES 1-2 mm into the external iliac artery is recommended.

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