Diagnosis and Endovascular Management of Transplant Renal Artery Stenosis: A Retrospective Two-Decade Study

Brankica Spasojevic Dimitrijeva; Milan Djukic; Ivana Gojkovic; Srdjan S Nikolovski; Dragan Sagic; Polina Pavicevic; Tijana Radovic; Dragan Vasic; Oliver Radmili; Igor Stefanovic; Mirjana Kostic; Mirjana Cvetkovic

doi:10.7759/cureus.80393

Diagnosis and Endovascular Management of Transplant Renal Artery Stenosis: A Retrospective Two-Decade Study

Cureus. 2025 Mar 11;17(3):e80393. doi: 10.7759/cureus.80393. eCollection 2025 Mar.

Authors

Brankica Spasojevic Dimitrijeva^{1

2}, Milan Djukic^{3

2}, Ivana Gojkovic¹, Srdjan S Nikolovski⁴, Dragan Sagic^{5

2}, Polina Pavicevic^{6

2}, Tijana Radovic⁶, Dragan Vasic⁷, Oliver Radmili⁷, Igor Stefanovic^{3

2}, Mirjana Kostic^{1

2}, Mirjana Cvetkovic^{1

2}

Affiliations

¹ Nephrology, University Children's Hospital, Belgrade, SRB.
² Faculty of Medicine, University of Belgrade, Belgrade, SRB.
³ Cardiology, University Children's Hospital, Belgrade, SRB.
⁴ Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Chicago, USA.
⁵ Invasive Diagnostics and Therapy, Institute for Cardiovascular Diseases "Dedinje", Belgrade, SRB.
⁶ Radiology, University Children's Hospital, Belgrade, SRB.
⁷ Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, SRB.

Abstract

Introduction Transplant renal artery stenosis (TRAS) is a potentially treatable posttransplant complication, primarily presenting with arterial hypertension and allograft dysfunction. Its prevalence in children with posttransplant hypertension ranges from 5% to 15%. Diagnosis is typically made through invasive angiography following suspicion raised by echo Doppler findings. Treatment options include medical therapy, percutaneous transluminal angioplasty (PTA)/stenting, and surgical revascularization. This study aimed to assess the efficacy, complications, and outcomes of PTA/stenting procedures in children with TRAS. Methods We reviewed all pediatric patients who underwent renal transplantation in Serbia between June 2001 and February 2023 to identify cases of TRAS treated with PTA. Statistical analysis was performed to compare pre- and post-intervention arterial vessel diameters, serum creatinine levels, estimated glomerular filtration rate (eGFR), mean blood pressure, systolic and diastolic blood pressure indices, and the number of antihypertensive medications used. Results Seven patients underwent PTA with or without stent placement for TRAS. None were treated solely with medical therapy or surgical intervention. The overall prevalence of TRAS was 6.32%, higher in cadaveric transplants (11.11%) compared to living-related transplants (3.39%). Of the seven patients, five underwent PTA alone, while two required stent placement. Two of the five PTA patients required re-interventions, resulting in a total of seven angioplasty procedures. No complications occurred following the procedures. After a mean follow-up of 56.86 ± 45.76 months, patients demonstrated improved blood pressure control and reduced use of antihypertensive medications. While the mean eGFR showed a nonsignificant improvement, one patient with severe concomitant cytomegalovirus disease progressed to grade IV chronic kidney disease. Conclusions PTA, with or without stenting, appears to be an effective and safe treatment for TRAS in children, with immediate and intermediate-term results comparable to those reported in the literature. Stent placement may be particularly suitable for adolescents who have completed their growth phase.

Keywords: angioplasty; blood pressure; glomerular filtration rate; kidney transplantation; renal artery obstruction; stents.