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

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Abstract

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 6.78–17.36 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 ± 1.4 (pre-PTA) vs. 1.04 ± 0.8 (post-PTA); p = 0.0006) and graft function [creatinine clearance: 69 ± 17.08 (pre-PTA) vs. 80.7 ± 21.5 ml/min/1.73 m2 (post-PTA); p = 0.006] 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.

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Via Giustiniani 2, 35128, Padova, Italy

    Giulia Ghirardo, Enrico Vidal, Elisa Benetti, Alberto Ferraro & Luisa Murer

  2. ICU, Cardiovascular Institute, University Hospital of Padua, Padua, Italy

    Marco De Franceschi

  3. Department of Medical Diagnostic Sciences and Special Therapies, University Hospital of Padua, Padua, Italy

    Alessandro Vidoni, Gaetano Ramondo, Raffaella Motta & Diego Miotto

  4. Pediatric Surgery Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy

    Giovanni Franco Zanon

Authors
  1. Giulia Ghirardo
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  2. Marco De Franceschi
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  3. Enrico Vidal
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  4. Alessandro Vidoni
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  5. Gaetano Ramondo
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  6. Elisa Benetti
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  7. Raffaella Motta
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  8. Alberto Ferraro
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  9. Giovanni Franco Zanon
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  10. Diego Miotto
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  11. Luisa Murer
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Corresponding author

Correspondence to Giulia Ghirardo.

Additional information

Diego Miotto and Luisa Murer contributed equally to this study.

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Ghirardo, G., De Franceschi, M., Vidal, E. et al. Transplant renal artery stenosis in children: risk factors and outcome after endovascular treatment. Pediatr Nephrol 29, 461–467 (2014). https://doi.org/10.1007/s00467-013-2681-7

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  • DOI: https://doi.org/10.1007/s00467-013-2681-7

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