Treatment of primary graft dysfunction after kidney transplantation by renal artery stent

Renal artery stenosis is a rare cause of primary graft failure after kidney transplantation [1]. Percutaneous transluminal angioplasty (PTA) is the treatment of choice, however, this technique has its limitations in elastic stenoses that are resistant to dilatation [2,3]. The procedure is of high risk, especially in the early phase after transplantation. If renal artery stenosis is refractory to PTA, the placement of an endovascular prosthesis (Palmaz stent) may be necessary. To our knowledge there are no reports in the literature regarding transplant renal artery stenting in the early period after transplantation. artery (Figure la). Renal biopsy ruled out rejection and other parenchymal disorders. Arterial angiography confirmed the CDS diagnosis and angioplasty was performed using a 5-mm dilation balloon (Figure 2a). However, due to elastic recoil, there was not much improvement angiographically and kidney function and blood pressure did not substantially improve. To overcome the remaining high-grade stenosis, an intravascular endoprosthesis (Palmaz stent, 10 mm in length, dilated up to 5 mm) was successfully implanted into the stenotic region (Figure 2b). Immediately thereafter, diuresis increased (3000 ml/day), serum creatinine level dropped to 141.4 umol/1, and blood pressure improved. Control CDS confirmed that the endoprosthesis was correctly placed with just a slight narrowing at the suture, but no turbulences were detected (Figure lb). Three months postoperatively, the patient had stable renal function with a serum creatinine of 123.7 umol/1.