Wang Lili, Liu Bin, Yan Jieke, Wang Yongzheng, Wang Wujie, Wang Wei, Chang Haiyang, Wang Hongwei, Wang Changjun, Li Zheng, Li Yuliang
1 Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China.
2 Department of Kidney Transplantation, the Second Hospital of Shandong University, Jinan, China.
Vasc Endovascular Surg. 2017 Jan;51(1):4-11. doi: 10.1177/1538574416682157. Epub 2016 Dec 19.
To evaluate the outcomes of percutaneous intervention (PI) for transplant renal artery stenosis (TRAS).
Doppler ultrasonography was used as the screening tool, and angiography was the diagnostic method for TRAS. The indications for PI were (1) a reduction in lumen diameter of >50% or (2) a mean pressure gradient of >15 mm Hg. Technical success was assessed immediately after the procedure. The short-term results of stenosis were evaluated by serum creatinine (Scr) levels and blood pressure (BP). The long-term results were assessed by graft survival and renal function.
From October 2009 to July 2015, a total of 660 patients had kidney transplantation and 22 cases underwent PI. The technical success was 100%. The mean Scr level preintervention was 321.6 ± 167.2 (range, 171.3-862.0) μmol/L, and it decreased to 145.3 ± 44.7 (range, 74.3-260.8) μmol/L 1 month postintervention ( P < .001). Blood pressure was also improved at 1 month postintervention, as assessed by systolic (157.0 ± 13.0 vs 131.0 ± 11.0 mm Hg, P < .001), diastolic (95.0 ± 5.0 vs 77.0 ± 9.0 mm Hg, P < .001), and mean arterial pressure (116.0 ± 7.0 vs 95.0 ± 9.0 mm Hg, P < .001). The patency rate was 100%, 91.7%, and 85.7% at 1, 3, and 12 months, respectively. The secondary patency rate was 100%. Graft survival was 100% during follow-up. There was no significant deterioration in graft function or BP ( P > .05) postintervention when compared to posttransplantation.
Percutaneous intervention for TRAS is safe and results in significant improvement both in allograft function and in BP.
评估经皮介入治疗（PI）移植肾动脉狭窄（TRAS）的疗效。
采用多普勒超声作为筛查工具，血管造影作为TRAS的诊断方法。PI的指征为：（1）管腔直径缩小>50%或（2）平均压力梯度>15 mmHg。术后立即评估技术成功率。通过血清肌酐（Scr）水平和血压（BP）评估狭窄的短期结果。通过移植物存活和肾功能评估长期结果。
2009年10月至2015年7月，共有660例患者接受肾移植，22例接受PI治疗。技术成功率为100%。干预前Scr平均水平为321.6±167.2（范围171.3 - 862.0）μmol/L，干预后1个月降至145.3±44.7（范围74.3 - 260.8）μmol/L（P <.001）。干预后1个月血压也有所改善，收缩压（157.0±13.0 vs 131.0±11.0 mmHg，P <.001）、舒张压（95.0±5.0 vs 77.0±9.0 mmHg，P <.001）和平均动脉压（116.0±7.0 vs 95.0±9.0 mmHg，P <.001）。1、3和12个月时通畅率分别为100%、91.7%和85.7%。二次通畅率为100%。随访期间移植物存活率为100%。与移植后相比，干预后移植物功能或BP无显著恶化（P>.05）。
经皮介入治疗TRAS安全有效，可显著改善移植肾功能和血压。
