Transplant Renal Artery Stenosis with Varied Clinical Presentations

Renal vascular complications constitute a clinically significant cause of morbidity following renal transplantation. Transplant renal artery stenosis (TRAS) is a well-recognized complication accounting for ~75% of posttransplant vascular complications. Early recognition and prompt correction of TRAS can prevent adverse outcomes, including graft loss. This series is a summary of four renal transplant recipients who developed TRAS at varied time periods and with varied clinical presentations. A 23-year-old male who presented after 1½ months of renal transplantation with accelerated hypertension was diagnosed with TRAS and was treated successfully with percutaneous transluminal angioplasty with stenting. A 26-year-old male with acute allograft dysfunction after 1 month of transplantation without worsening hypertension was diagnosed with TRAS, which was treated successfully with angioplasty and stenting. A 49-year-old male who presented to the emergency with pulmonary edema secondary to accelerated hypertension (Pickering syndrome) after 2 months of transplantation was diagnosed to have TRAS, which was treated successfully with angioplasty with stenting. A 44-year-old male with an incidentally detected TRAS-like clinical picture secondary to kinking in the transplant renal artery in the immediate posttransplant period was successfully treated with re-exploration and repair. All the patients were screened with Doppler ultrasonogram and computed tomogram-angiography supported the diagnosis in three of the cases. None of the cases developed procedure-related complications including contrast-associated nephropathy. All the patients on follow-up after 6 months of the intervention are normotensive with normal renal function. A high index of suspicion is required in the early identification of TRAS, which is a reversible cause of hypertension and graft dysfunction. The risk of contrast-associated nephropathy cannot hinder or delay the diagnosis especially, in emerging transplant centers. The endovascular procedures used today for the treatment of TRAS are safe with high technical success rates.