#2435 The impact of resistive index on kidney allograft and transplant recipients’ survival after successful transplant renal artery stenosis stenting

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Abstract Background and Aims Transplant renal artery stenosis (TRAS) is the most common vascular complication after kidney transplantation (KTx). Duplex ultrasonography (DUS) is a primary noninvasive modality for diagnosing of TRAS. The prompt surgical repair of TRAS leads to significant regression of kidney allograft (KA) dysfunction and stabilization of blood pressure indicators. The objective of this study is to investigate the impact of resistive index (RI) after successful percutaneous transluminal stenting (PTS) on the survival of KA and recipients. Method 62 patients after successful PTS were included into a single-center retrospective study from June 2018 to June 2024. The diagnosis of TRAS was detected by DUS. 58 patients underwent control DUS in 7–10 days after PTS, 2 patients were lost for follow-up. The peak systolic velocity (Vmax) and the minimal diastolic velocity (Vmin) were determined in the segmental arteries with a convex transducer (Vivid E90, GE, USA). The RI was calculated as [1−(Vmin ÷ Vmax)]. Results of three measurements at three places in the transplant (lower/middle/upper parts) were averaged measured RI. The combined end point was terminal transplant failure requiring the re-institution of dialysis or death from any cause. Statistical analysis was performed using the STATISTICA 13 and Online ROC Curve Calculator (Johns Hopkins University School of Medicine). Results A total of 56 recipients were included. In a ROC analysis, we defined a cut-off value of the RI of 0.79 (True Positive Fraction 0.82, False Positive Fraction 0.12, Fitted ROC Area 0.9). Therefore, the observation group was divided into two subgroups: (1 sgr) 45 patients with an RI < 0.79 and (2 sgr) 11 patients with an RI ≥ 0.79. The results of comparative analyses of demographic, clinical and laboratory data are presented in Table. The study subgroups did not significantly differ in age, gender, donor's age, Diabetes Mellitus, duration of replacement therapy, mean Blood Pressure, Pulse Pressure and Pcr at the time of TRAS diagnosis. Patients with an RI of 0.79 or higher were more likely to suffer from coronary heart disease and chronic occlusive disease of the lower limb arteries. The significant differences in Pcr were detected in subgroups within 7–10 days and a month after PTS, the patients with an RI of 0.79 or higher demonstrated higher Pcr. 3 (27.3 %) patients with an RI of 0.79 or higher have lost graft function (1 patient – KTx, 2 patients – hemodialysis) and 2 patients (18.2 %) died (1 – from sepsis, 1 – from progressive heart failure). All patients with an RI of less than 0.79 are alive with preserved KA function. The results of cumulative survival are presented in the Fig. 1. Conclusion RI of 0.79 or higher after successful PTS in patients with TRAS, as compared with a lower RI, is associated with progressive renal dysfunction and adverse outcomes.

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