Transplant Renal Artery Stenosis Experience from a Single Center in South India

Introduction: Allograft dysfunction and loss due to rejection have declined with modern immunosuppression. Consequently, other complications such as recurrent disease, drug toxicity, infections, and vascular abnormalities have gained prominence. Transplant renal artery stenosis (TRAS) can cause resistant hypertension, fluid overload, and graft dysfunction, and if unrecognized, may progress to graft loss. Aims and Objectives: The study aimed to describe the clinical profile of patients with clinically significant TRAS, to evaluate its associations with demographic characteristics, donor and recipient comorbidities, and surgical techniques, to correlate clinical features with imaging findings and the degree of stenosis, and finally to assess the percutaneous transluminal renal angioplasty (PTRA) profile and outcomes. Material and Methods: This was a retrospective study of renal transplant recipients at Manipal Hospitals, Bangalore, between 2023 and 2024. All patients with clinically significant TRAS were included. Data on demographics, native kidney disease, donor and surgical details, imaging, and post-transplant outcomes were retrieved from electronic records. Statistical analysis involved descriptive statistics, Kaplan–Meier survival, and Cox regression for predictors of graft loss. Results: Eighteen patients were identified. The mean age was 45 years (range 18–65), with a male predominance (88.9%). IgA nephropathy (27.8%) and diabetic nephropathy (22.2%) were the most common native diseases. Hypertension was nearly universal, and 44.4% had diabetes. Vascular comorbidities were present in 38.8% of patients, including coronary artery disease in 22.2% and peripheral arterial disease in 16.7%. Three patients presented with acute pulmonary edema. Most donors were female (83.3%), with a mean age of 47 years; two recipients underwent deceased donor and two underwent robotic transplants. Conclusion: TRAS occurred more frequently in middle-aged hypertensive males with systemic vascular disease. Early recognition and PTRA stabilized graft function, underscoring the need for vigilant screening and multidisciplinary care.