Outcomes of endovascular interventions for salvage of renal transplant allografts

Introduction: Renal transplantation has been performed with increasing frequency, and interventions to preserve graft function and integrity have been steadily increasing. This study examines the outcomes of endovascular therapy based on indication for renal transplant allograft salvage. Methods: A prospective transplant registry was queried for all patients undergoing endovascular interventions for transplant allograft salvage from 2002 to 2011. Demographics, perioperative data, and transplant function outcomes were extracted and analyzed. Results: Among 34 renal transplant recipients (62% men) who underwent endovascular interventions for graft salvage, the mean age was 48.2 years (range, 18-74 years). The indications for intervention included worsening renal function in 15, renovascular hypertension in 11, and structural abnormalities identified on noninvasive imaging in eight. Transluminal angioplasty with and without stenting was done in 26 patients: 14 patients (41.2%) with significant transplant stenosis, 11 (32.4%) with peripheral arterial disease in proximal iliac vessels, and one patient with iliac dissection. Five arteriovenous fistulas and two pseudoaneurysms required embolization. One patient required lysis for deep venous thrombosis causing obstruction of allograft outflow. There were no periprocedural deaths, and 30-day morbidity was 17.6%. Renal function improved or stabilized in 67% of patients with worsening renal function. Better blood pressure control was achieved in patients with renovascular hypertension. Mean follow-up was 4.2 years. There were no significant differences in transplant allograft survival during the duration of follow-up based on primary indication for endovascular intervention, but transplant graft survival at follow-up was significantly better in patients with renovascular hypertension at the initial endovascular intervention. Conclusions: Endovascular salvage of renal allograft transplants can be safely done for various indications. The maximum benefit in renal function as assessed by serum creatinine and control of blood pressure is seen in patients with worsening renal function and in the presence of renovascular hypertension, respectively. Long-term transplant graft function was significantly better in patients with renovascular hypertension at the initial endovascular intervention.