Document Detail


Long-term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention.
MedLine Citation:
PMID:  18435786     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The natural history and optimal treatment of transplant renal artery stenosis (TRAS) is poorly defined. Few studies reported long-term clinical outcomes. A single centre analysis of 43 patients diagnosed with TRAS 1990-2003 was performed. Twenty-seven had percutaneous intervention (including 10 patients who had >1 intervention) and 16 were managed conservatively at the discretion of the attending clinicians. Transplant function was assessed by slope of estimated glomerular filtration rate (eGFR) over five yr of follow-up. Patients in the intervention group had lower mean eGFR (36.3 mL/min/1.73 m(2) vs. 46.3 mL/min/1.73 m(2); p = 0.07) at baseline. Five transplants in the intervention group failed (including two as a direct result of intervention) and one in the conservative group failed. There was no significant difference in the rate of deterioration in renal function (mean slope of eGFR minus 0.8 mL/min/yr and minus 1.0 mL/min/yr in the intervention and conservative groups, respectively; p = 0.79). There was no significant difference in blood pressure or number of anti-hypertensive agents between the groups at any time point. Baseline Doppler ultrasound indices showed no significant correlation with slope of eGFR in either group. Our data demonstrate that selected patients with TRAS can be managed without intervention and that this approach is associated with good long-term outcome. Selection of appropriate patients for intervention remains difficult and larger randomized studies are required.
Authors:
Colin C Geddes; Siobhan K McManus; Shiva Koteeswaran; Grant M Baxter
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-04-23
Journal Detail:
Title:  Clinical transplantation     Volume:  22     ISSN:  1399-0012     ISO Abbreviation:  Clin Transplant     Publication Date:    2008 Sep-Oct
Date Detail:
Created Date:  2008-10-07     Completed Date:  2009-03-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710240     Medline TA:  Clin Transplant     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  572-8     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Western Infirmary, Glasgow, Scotland, UK. colin.geddes@northglasgow.scot.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty*
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kidney Transplantation / adverse effects*
Male
Middle Aged
Predictive Value of Tests
Pulsatile Flow
Renal Artery Obstruction / etiology,  surgery*,  ultrasonography
Stents*
Survival Analysis
Thrombosis / etiology,  surgery*,  ultrasonography
Ultrasonography, Doppler, Color

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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