Treatment of Transplant Renal Artery Stenosis with Expandable Metal Stent

Moon, Jang Il; Kim, Soon Il; Kim, Yu Seun; Park, Ki Il

Abstract

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.