Transplant renal artery stenosis in children: risk factors and outcome after endovascular treatment

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• 作者：Giulia Ghirardo (1)
  Marco De Franceschi (2)
  Enrico Vidal (1)
  Alessandro Vidoni (3)
  Gaetano Ramondo (3)
  Elisa Benetti (1)
  Raffaella Motta (3)
  Alberto Ferraro (1)
  Giovanni Franco Zanon (4)
  Diego Miotto (3)
  Luisa Murer (1)
  
• 关键词：Children ; Renal artery stenosis ; Transplantation ; Kidney
• 刊名：Pediatric Nephrology
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：29
• 期：3
• 页码：461-467
• 全文大小：178 KB
• 作者单位：Giulia Ghirardo (1)
  Marco De Franceschi (2)
  Enrico Vidal (1)
  Alessandro Vidoni (3)
  Gaetano Ramondo (3)
  Elisa Benetti (1)
  Raffaella Motta (3)
  Alberto Ferraro (1)
  Giovanni Franco Zanon (4)
  Diego Miotto (3)
  Luisa Murer (1)
  
  1. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Via Giustiniani 2, 35128, Padova, Italy
  2. ICU, Cardiovascular Institute, University Hospital of Padua, Padua, Italy
  3. Department of Medical Diagnostic Sciences and Special Therapies, University Hospital of Padua, Padua, Italy
  4. Pediatric Surgery Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy
  
• ISSN：1432-198X

文摘

Background Transplant renal artery stenosis (TRAS) is an increasingly recognised cause of post-transplant hypertension. Methods We retrospectively analysed 216 paediatric renal recipients transplanted between 2001 and 2011 to assess TRAS prevalence and percutaneous transluminal angioplasty (PTA) efficacy. To assess risk factors, we compared children with TRAS with a propensity score-matched cohort of recipients without TRAS. Results Of the 216 paediatric patients who were transplanted in the study period, 44 were hypertensive (prevalence 20.3?%) and ten presented with TRAS (prevalence 4.6?%, median age at transplantation 14?years, range 6.78-7.36 years). Hypertensive patients without TRAS were prescribed one to two anti-hypertensive agents, whereas patients with TRAS required one to five medications. In the TRAS group, one recipient presented with vascular complications during surgery, and in three patients the graft had vascular abnormalities. TRAS was detected by Doppler ultrasonography (US) performed due to hypertension in nine of the patients with TRAS, but in the tenth case the TRAS was clinically silent and detected by routine Doppler-US screening. TRAS diagnosis was refined using angio-computed tomography or angio-magnetic resonance imaging. All patients underwent PTA without complications. Significant improvement after PTA was observed in the standard deviation scores for blood pressure [3.2?±-.4 (pre-PTA) vs. 1.04?±-.8 (post-PTA); p--.0006) and graft function [creatinine clearance: 69?±-7.08?(pre-PTA) vs. 80.7?±-1.5?ml/min/1.73?m2 (post-PTA); p--.006] We observed no significant differences between the two cohorts for cold ischaemia time, recipient/donor weight ratio, delayed graft function, cytomegalovirus infections and acute rejection episodes. Conclusions Our study reports a low but significant TRAS prevalence among the paediatric patients who were transplanted at our centre in the study period and confirms that PTA is an effective and safe therapeutic option in paediatric renal transplant recipients. Known risk factors do not appear to be related to the development of TRAS.