Transplant renal artery stenosis (TRAS): Hemodynamically significant narrowing of donor renal artery; often juxtaanastomotic in location; incidence of 3-12%
Clinical manifestations
Refractory hypertension
Renal insufficiency (e.g., creatinine > 1.3-1.6)
Causes
Early: Arterial kinking
Late: Anastomotic stenosis, intimal hyperplasia
Less common: Extrinsic compression by perigraft fibrosis
Proximal pseudostenosis of transplant renal artery (pseudo-TRAS)
Consider percutaneous/transcatheter ablation of renal transplant with ethanol
Prior to nephrectomy to reduce bleeding
Deceased-donor renal transplant
Procure renal artery with portion of aorta; anastomosed end-to-side to recipient common/external iliac artery (CIA/EIA)
82% 5-year survival rate
Living-donor renal transplant
Procure renal artery without aorta; anastomosed end-to-side to recipient EIA, or end-to-end to recipient internal iliac artery (IIA)
90% 5-year survival rate
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Postprocedure Imaging
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Banas B et al: Long-term kidney transplant outcomes: role of prolonged-release tacrolimus. Transplant Proc. 52(1):102-10, 2020
Cao C et al: Temporary covered metallic ureteral stent placement for ureteral strictures following kidney transplantation: experience in 8 patients. J Vasc Interv Radiol. 31(11):1795-800, 2020
Voora S et al: Management of kidney transplant recipients by general nephrologists: core curriculum 2019. Am J Kidney Dis. 73(6):866-79, 2019
Coussement J et al: Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Database Syst Rev. 2:CD011357, 2018
Copelan A et al: Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol. 32(2):133-55, 2015
Iezzi R et al: Interventional radiological treatment of renal transplant complications: a pictorial review. Korean J Radiol. 16(3):593-603, 2015
Ngo AT et al: A systematic review of outcomes following percutaneous transluminal angioplasty and stenting in the treatment of transplant renal artery stenosis. Cardiovasc Intervent Radiol. 38(6):1573-88, 2015
Galazka Z et al: Is severe atherosclerosis in the aortoiliac region a contraindication for kidney transplantation? Transplant Proc. 43(8):2908-10, 2011
Marini M et al: Treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and/or stenting: study in 63 patients in a single institution. Transplant Proc. 43(6):2205-7, 2011
Nankivell BJ et al: Diagnosis and prevention of chronic kidney allograft loss. Lancet. 378(9800):1428-37, 2011
Pawlicki J et al: Risk factors for early hemorrhagic and thrombotic complications after kidney transplantation. Transplant Proc. 43(8):3013-7, 2011
Hedegard W et al: Management of vascular and nonvascular complications after renal transplantation. Tech Vasc Interv Radiol. 12(4):240-62, 2009
Saad WE et al: Percutaneous nephrostomy: native and transplanted kidneys. Tech Vasc Interv Radiol. 12(3):172-92, 2009
Kobayashi K et al: Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 27(4):1109-30, 2007
Beecroft JR et al: Transplant renal artery stenosis: outcome after percutaneous intervention. J Vasc Interv Radiol. 15(12):1407-13, 2004
Surlan M et al: The role of interventional radiology in management of patients with end-stage renal disease. Eur J Radiol. 46(2):96-114, 2003
Patel NH et al: Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. 219(3):663-7, 2001
Perini S et al: Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome. J Vasc Interv Radiol. 9(6):1011-9, 1998
Kuzuhara K et al: Ethanol ablation of lymphocele after renal transplantation: a minimally invasive approach. Transplant Proc. 29(1-2):147-50, 1997
Lorenzo V et al: Ablation of irreversibly rejected renal allograft by embolization with absolute ethanol: a new clinical application. Am J Kidney Dis. 22(4):592-5, 1993
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Outcomes
TERMINOLOGY
Definitions
Transplant renal artery stenosis (TRAS): Hemodynamically significant narrowing of donor renal artery; often juxtaanastomotic in location; incidence of 3-12%
Clinical manifestations
Refractory hypertension
Renal insufficiency (e.g., creatinine > 1.3-1.6)
Causes
Early: Arterial kinking
Late: Anastomotic stenosis, intimal hyperplasia
Less common: Extrinsic compression by perigraft fibrosis
Proximal pseudostenosis of transplant renal artery (pseudo-TRAS)
Consider percutaneous/transcatheter ablation of renal transplant with ethanol
Prior to nephrectomy to reduce bleeding
Deceased-donor renal transplant
Procure renal artery with portion of aorta; anastomosed end-to-side to recipient common/external iliac artery (CIA/EIA)
82% 5-year survival rate
Living-donor renal transplant
Procure renal artery without aorta; anastomosed end-to-side to recipient EIA, or end-to-end to recipient internal iliac artery (IIA)
90% 5-year survival rate
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Postprocedure Imaging
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Banas B et al: Long-term kidney transplant outcomes: role of prolonged-release tacrolimus. Transplant Proc. 52(1):102-10, 2020
Cao C et al: Temporary covered metallic ureteral stent placement for ureteral strictures following kidney transplantation: experience in 8 patients. J Vasc Interv Radiol. 31(11):1795-800, 2020
Voora S et al: Management of kidney transplant recipients by general nephrologists: core curriculum 2019. Am J Kidney Dis. 73(6):866-79, 2019
Coussement J et al: Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Database Syst Rev. 2:CD011357, 2018
Copelan A et al: Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol. 32(2):133-55, 2015
Iezzi R et al: Interventional radiological treatment of renal transplant complications: a pictorial review. Korean J Radiol. 16(3):593-603, 2015
Ngo AT et al: A systematic review of outcomes following percutaneous transluminal angioplasty and stenting in the treatment of transplant renal artery stenosis. Cardiovasc Intervent Radiol. 38(6):1573-88, 2015
Galazka Z et al: Is severe atherosclerosis in the aortoiliac region a contraindication for kidney transplantation? Transplant Proc. 43(8):2908-10, 2011
Marini M et al: Treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and/or stenting: study in 63 patients in a single institution. Transplant Proc. 43(6):2205-7, 2011
Nankivell BJ et al: Diagnosis and prevention of chronic kidney allograft loss. Lancet. 378(9800):1428-37, 2011
Pawlicki J et al: Risk factors for early hemorrhagic and thrombotic complications after kidney transplantation. Transplant Proc. 43(8):3013-7, 2011
Hedegard W et al: Management of vascular and nonvascular complications after renal transplantation. Tech Vasc Interv Radiol. 12(4):240-62, 2009
Saad WE et al: Percutaneous nephrostomy: native and transplanted kidneys. Tech Vasc Interv Radiol. 12(3):172-92, 2009
Kobayashi K et al: Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 27(4):1109-30, 2007
Beecroft JR et al: Transplant renal artery stenosis: outcome after percutaneous intervention. J Vasc Interv Radiol. 15(12):1407-13, 2004
Surlan M et al: The role of interventional radiology in management of patients with end-stage renal disease. Eur J Radiol. 46(2):96-114, 2003
Patel NH et al: Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. 219(3):663-7, 2001
Perini S et al: Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome. J Vasc Interv Radiol. 9(6):1011-9, 1998
Kuzuhara K et al: Ethanol ablation of lymphocele after renal transplantation: a minimally invasive approach. Transplant Proc. 29(1-2):147-50, 1997
Lorenzo V et al: Ablation of irreversibly rejected renal allograft by embolization with absolute ethanol: a new clinical application. Am J Kidney Dis. 22(4):592-5, 1993
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