Spasojevic Dimitrijeva Brankica, Djukic Milan, Gojkovic Ivana, Nikolovski Srdjan S, Sagic Dragan, Pavicevic Polina, Radovic Tijana, Vasic Dragan, Radmili Oliver, Stefanovic Igor, Kostic Mirjana, Cvetkovic Mirjana
Nephrology, University Children's Hospital, Belgrade, SRB.
Faculty of Medicine, University of Belgrade, Belgrade, SRB.
Cureus. 2025 Mar 11;17(3):e80393. doi: 10.7759/cureus.80393. eCollection 2025 Mar.
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.
引言
移植肾动脉狭窄（TRAS）是一种潜在可治疗的移植后并发症，主要表现为动脉高血压和移植肾功能障碍。其在移植后高血压儿童中的患病率为5%至15%。通常在经超声多普勒检查结果引发怀疑后，通过有创血管造影进行诊断。治疗选择包括药物治疗、经皮腔内血管成形术（PTA）/支架置入术以及外科血管重建术。本研究旨在评估PTA/支架置入术治疗儿童TRAS的疗效、并发症及预后。
方法
我们回顾了2001年6月至2023年2月期间在塞尔维亚接受肾移植的所有儿科患者，以确定接受PTA治疗的TRAS病例。进行统计分析以比较干预前后的动脉血管直径、血清肌酐水平、估计肾小球滤过率（eGFR）、平均血压、收缩压和舒张压指数以及使用的抗高血压药物数量。
结果
7例患者因TRAS接受了有或无支架置入的PTA治疗。无人仅接受药物治疗或外科干预。TRAS的总体患病率为6.32%，尸体肾移植（11.11%）高于亲属活体肾移植（3.39%）。7例患者中，5例仅接受了PTA治疗，2例需要置入支架。5例PTA患者中有2例需要再次干预，共进行了7次血管成形术。术后未发生并发症。平均随访56.86±45.76个月后，患者的血压控制得到改善，抗高血压药物的使用减少。虽然平均eGFR有非显著性改善，但1例伴有严重巨细胞病毒疾病的患者进展为IV级慢性肾脏病。
结论
有或无支架置入的PTA似乎是治疗儿童TRAS的一种有效且安全的方法，其近期和中期结果与文献报道相当。支架置入可能特别适合已完成生长阶段的青少年。
