From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.).
Radiology. 2019 Feb;290(2):555-563. doi: 10.1148/radiol.2018181320. Epub 2018 Nov 6.
Purpose To compare long-term graft and patient survival after percutaneous angioplasty (PTA) or stent placement for transplant renal artery stenosis (TRAS) with a control cohort without TRAS. Materials and Methods This is a retrospective matched cohort study of 41 patients (median age, 49 years; range, 18-72 years), including 27 male patients (median age, 48 years; range, 18-67 years) and 14 female patients (median age, 52 years; range, 24-68 years), with TRAS from December 1995 through 2016. Primary end points were death-censored graft and patient survival, compared by using log-rank test and Cox proportional regression. Secondary outcomes were improvement in renal function, blood pressure (BP), and complications. Results Twenty-four patients underwent PTA and 17 received stent placements. Ten-year graft survival was 92.1% (range, 83.2%-100%) versus 81.4% (range, 67.8%-95.3%) (P = .56), and 10-year patient survival was 89.9% (79.1%-100%) versus 84.7% (72.1%-97.5%) (P = .49), for the study and control groups, respectively. Five patients (12%) resumed dialysis in each group and a total of 17 patients died (eight in the study group and nine in the control group). Most patients died with a functioning graft (seven of eight in the study group and seven of nine in the control group). Posttreatment median systolic and diastolic BP improved by 12% and 7.4%, respectively, and serum creatinine improved by 27%. Normal systolic BP and serum creatinine level at 1 year after treatment were associated with better survival for patients (P = .04; hazard ratio [HR], 1.04; 95% confidence interval [CI]: 1.0, 1.075) and grafts (P < .001; HR, 1.02; 95% CI: 1.0, 1.027). Other covariates, including PTA versus renal stent placement, intra-arterial pressure gradient greater than 10%, diastolic BP, age at transplantation, sex, graft type, rejection, and delayed graft function, were not significant. Five patients (12.2%) had a complication (Society of Interventional Radiology class A, two of 41 [4.9%]; class B, two of 41 [4.9%]; and class D, one of 41 [2.4%]); 30-day graft loss and patient mortality were zero. Conclusion Long-term graft and patient survival after endovascular correction of transplant renal artery stenosis (TRAS) was similar to that without TRAS and most patients avoided returning to dialysis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Dickey and Durrani in this issue.
目的 比较经皮血管成形术（PTA）或支架置入治疗移植肾动脉狭窄（TRAS）与无 TRAS 的对照队列的长期移植物和患者存活率。
材料与方法 这是一项回顾性匹配队列研究，纳入了 41 例 TRAS 患者（中位年龄，49 岁；范围，18-72 岁），包括 27 例男性患者（中位年龄，48 岁；范围，18-67 岁）和 14 例女性患者（中位年龄，52 岁；范围，24-68 岁）。TRAS 发生于 1995 年 12 月至 2016 年。主要终点是使用对数秩检验和 Cox 比例风险回归比较死亡校正移植物和患者存活率。次要结局是肾功能、血压（BP）和并发症的改善。
结果 24 例患者接受了 PTA，17 例接受了支架置入。研究组和对照组的 10 年移植物存活率分别为 92.1%（范围，83.2%-100%）和 81.4%（范围，67.8%-95.3%）（P=.56），10 年患者存活率分别为 89.9%（79.1%-100%）和 84.7%（72.1%-97.5%）（P=.49）。每组各有 5 例（12%）患者恢复透析，共有 17 例患者死亡（研究组 8 例，对照组 9 例）。大多数患者在移植物功能正常的情况下死亡（研究组 7 例，对照组 7 例）。治疗后，收缩压和舒张压中位数分别改善了 12%和 7.4%，血清肌酐改善了 27%。治疗后 1 年时，收缩压和血清肌酐正常与患者（P=.04；风险比[HR]，1.04；95%置信区间[CI]：1.0，1.075）和移植物（P<.001；HR，1.02；95%CI：1.0，1.027）的更好存活率相关。其他协变量，包括 PTA 与肾支架置入、动脉内压力梯度>10%、舒张压、移植时年龄、性别、移植物类型、排斥和延迟移植物功能，均无统计学意义。5 例（12.2%）患者发生并发症（介入放射学会分级 A，41 例中有 2 例[4.9%]；分级 B，41 例中有 2 例[4.9%]；分级 D，41 例中有 1 例[2.4%]）；无 30 天移植物丢失和患者死亡。
结论 经血管内纠正移植肾动脉狭窄（TRAS）后的长期移植物和患者存活率与无 TRAS 相似，大多数患者避免了恢复透析。
