#1265 Trends in creatinine and blood pressure after stent implantation in patients with significant stenosis of the renal arteries after kidney transplantation

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Abstract Background and Aims Transplant renal artery stenosis (TRAS) is the most common vascular complication after kidney transplantation (KTx). The main clinical manifestations of TRAS are treatment-resistant hypertension and graft dysfunction. Endovascular intervention results in significant regression of graft dysfunction and stabilization of blood pressure (BP). The objective of the presented study is to analyze the features of the TRAS clinical picture along with the trends of plasma creatinine (Pcr) and mean BP (mBP) after successful percutaneous transluminal stenting (PTS). Method The single center retrospective study was conducted from June 2018 to June 2024. The diagnosis of TRAS was detected by duplex ultrasonography. In 32 recipients (51.6%) computed tomography angiography was done after duplex ultrasonography. The comparative analysis of Pcr (level before TRAS, at the time of TRAS diagnosis, 7–10 days and a month after PTS) and indicators of mBP (at the time of TRAS diagnosis and 7–10 days after PTS) was conducted. Statistical analysis was performed using the STATISTICA 13 (Mediana (Me) [IQR 25%; 75%], Wilcoxon-test). Results A total of 62 recipients were included, all allografts from deceased donors. Age of patients was 20–70 y, Mediana (Me) age—45 y [(IQR) 40; 54], female 43.5%. Body mass index 16.2–46.3 kg/m2, Me 24.3 kg/m2 [20.4; 27.2]. The most common cause of end stage renal disease was chronic glomerulonephritis (29%), 13 patients (21%) suffered from Diabetes Mellitus (in 8 recipients it was the cause of ESRD, in 5—posttransplant diabetes). 12 patients (19.3%) had coronary heart disease. 3 patients underwent pre-emptive KTx, the vintage of renal replacement therapy was 2 mo and16 y, Me 24 mo [12; 48], 12 patients (19.3%) had more, than one KTx. The donor's age was 30–63 y, Me 48.8 y [12.0; 16.75]. 22 recipients (35.5%) had delayed allograft function, the time of cold ischemia was 8.5–23.5 h, Me 14.0 h [12.0; 16.75]. The period between KTx and TRAS diagnosis was 2 mo and21 y, Me 6 mo [4.5; 16.1]. During a year after KTx TRAS was diagnosed in 46 recipients (74.2%). The clinical picture of TRAS was presented by a combination of progressive allograft dysfunction and treatment-resistant hypertension in 28 patients (45.2%), isolated allograft dysfunction in 23 (37%) and isolated treatment-resistant hypertension in 11 (17.7%). The successful PTS resulted in a decrease in Pcr by 20 µmol/L or more 7–10 days after the intervention in 42 recipients (67.7%), and a month after intervention in 48 (77.4%). mBP decreased by 10 mmHg or more 7–10 days after the intervention in 44 recipients (71%). Pcr level before TRAS was Me 160 µmol/L [130; 180], Pcr at the time of TRAS diagnosis—Me 201 µmol/L [172; 277], Pcr 7–10 days after PTS—Me 167 µmol/L [135; 212], Pcr a month after PTS—Me 155 µmol/L [126; 199]. mBP at the time of TRAS diagnosis was Me 120 mmHg [103; 131], mBP 7–10 days after PTS—Me 97 mmHg [93; 100]. The dynamics of Pcr and mBP are presented in Figs 1 and 2. Conclusion TRAS may manifest as isolated allograft dysfunction in the setting of stable BP in many recipients. Duplex ultrasonography should be conducted on all patients with progressive allograft dysfunction despite BP parameters. Successful PTS results in remarkable improvement in allograft function and reduced BP parameters.

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