Original Report: Patient-Oriented, Translational Research

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS
Frank P. Hurst^a, Kevin C. Abbott^a, Robert T. Neff^a, Eric A. Elster^b, Edward M. Falta^b, Krista L. Lentine^c, Lawrence Y. Agodoa^d, Rahul M. Jindal^b

Departments of
^aNephrology and
^bSurgery, Walter Reed AMC, Washington, D.C.,
^cCenter for Outcomes Research, St. Louis University School of Medicine, St. Louis, Mo.,
^dNational Institute of Diabetes, Digestive and Kidney Disorders, National Institutes of Health, Bethesda, Md., USA

Address of Corresponding Author

Am J Nephrol 2009;30:459-467 (DOI: 10.1159/000242431)

  Key Words

• Transplant renal artery stenosis
• Kidney transplantation
• Immunosuppression
• Graft survival
• Ischemic heart disease

  Abstract

Objective: We analyzed the United States Renal Data System registry to study the risks, predictors, and outcomes of transplant renal artery stenosis (TRAS) in contemporary practice. Methods: The study sampled comprised adults with Medicare primary insurance who received kidney transplants in 2000-2005. We examined associations of recipient, donor and transplant factors with time-to-TRAS by the Kaplan-Meier method and multivariate Cox regression. Survival analysis methods were employed to estimate graft survival after TRAS, and to model TRAS as a time-dependent outcome predictor. Kaplan-Meier analysis was used to estimate time to allograft loss in patients who did or did not have an angioplasty procedure for TRAS. Results: There were 823 cases of TRAS among 41,867 transplant patients, with an incidence rate of 8.3 (95% CI 7.8-8.9) cases per 1,000 patient-years. Mean time to diagnosis of TRAS was 0.83 ± 0.81 years after transplant. Factors associated with TRAS were older recipient and donor age, extended criteria donors, induction immunosuppression, delayed graft function, and ischemic heart disease. There was no association of TRAS with deceased donors, prolonged cold ischemia time, acute rejection or cytomegalovirus status. TRAS was associated with increased risk of graft loss (including death; adjusted hazard ratio 2.84, 95% CI 1.70-4.72). Among the 823 patients with TRAS, 145 (17.6%) underwent angioplasty. Graft survival after TRAS was not significantly different in patients treated with angioplasty compared to those without angioplasty. Conclusions: TRAS is an important complication that predicts adverse patient and graft outcomes. Treatment strategies for TRAS warrant prospective investigation in clinical trials.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Rahul M. Jindal, MD, PhD
Department of Organ Transplant, Walter Reed AMC
6630 Georgia Ave.
Washington, DC 20307 (USA)
Tel. +1 202 782 6462, Fax +1 202 782 3186, E-Mail jindalr@msn.com

  Article Information

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army, the Department of Defense, the National Institutes of Health, or the US government.

Received: July 31, 2009
Accepted: August 20, 2009
Published online: September 24, 2009
Number of Print Pages : 9
Number of Figures : 3, Number of Tables : 3, Number of References : 16