PMID- 10485378 OWN - NLM STAT- MEDLINE DCOM- 19991014 LR - 20191103 IS - 0902-0063 (Print) IS - 0902-0063 (Linking) VI - 13 IP - 4 DP - 1999 Aug TI - Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. PG - 349-55 AB - BACKGROUND: Renal transplant artery stenosis (RTAS) continues to be a problematic, but potentially correctable, cause of post-transplant hypertension and graft dysfunction. Older transplant recipients, prone to peripheral vascular disease (PVD), may have pseudoRTAS with PVD involving their iliac system. METHODS: We retrospectively analyzed 819 patients who underwent kidney transplantation between 1993 and 1997 to determine the contribution of pseudoRTAS to renal transplant renovascular disease. Univariate analyses were performed for donor and recipient variables, including age, weight, gender, race, renal disease, cholesterol and creatinine values, human leukocyte antigen (HLA) matching, cytomegalovirus (CMV) infection, and immunosuppressive medications. Significant variables were then analyzed by a Cox proportional hazards model. RESULTS: Ninety-two patients (11.2%) underwent renal transplant arteriogram (Agram) or magnetic resonance angiography (MRA) for suspected RTAS. RTAS or pseudoRTAS, defined as one or more hemodynamically significant lesions in the transplant artery or iliac system, was evident in 44 patients (5.4%). Variables significantly associated with RTAS by univariate analysis were weight at the time of transplant (p = 0.0258), male gender (p = 0.034), discharge serum creatinine > 2 mg/dL (p = 0.0041), and donor age (p = 0.0062). Variables significantly associated with pseudoRTAS by univariate analysis were weight at the time of transplant (p = 0.0285), recipient age (p = 0.0049), insulin-dependent diabetes mellitus (IDDM; p = 0.0042), panel reactive antibody (PRA) at transplant (p = 0.018), and body mass index (p = 0.04). Weight at transplant and donor age remained significantly associated with an increased risk for RTAS in a multivariate stepwise Cox proportional hazards model. IDDM, transplant PRA, weight at transplant, and donor age were significantly associated with an increased risk for pseudoRTAS in a multivariate stepwise Cox proportional hazards model. Importantly, both RTAS and pseudoRTAS were associated with poorer graft survival (p < 0.007 for each). CONCLUSIONS: Renal transplant renovascular disease encompasses pre-existing PVD acting as pseudoRTAS, as well as classical RTAS. Efforts to identify and correct renal transplant renovascular disease of either nature are important, given its negative impact on graft survival. FAU - Becker, B N AU - Becker BN AD - Department of Medicine, University of Wisconsin Medical School, Madison 53792, USA. bnb@medicine.wisc.edu FAU - Odorico, J S AU - Odorico JS FAU - Becker, Y T AU - Becker YT FAU - Leverson, G AU - Leverson G FAU - McDermott, J C AU - McDermott JC FAU - Grist, T AU - Grist T FAU - Sproat, I AU - Sproat I FAU - Heisey, D M AU - Heisey DM FAU - Collins, B H AU - Collins BH FAU - D'Alessandro, A M AU - D'Alessandro AM FAU - Knechtle, S J AU - Knechtle SJ FAU - Pirsch, J D AU - Pirsch JD FAU - Sollinger, H W AU - Sollinger HW LA - eng GR - DK02420/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - Denmark TA - Clin Transplant JT - Clinical transplantation JID - 8710240 SB - IM MH - Adult MH - Arterial Occlusive Diseases/diagnosis/*etiology MH - Female MH - Humans MH - Hypertension, Renovascular/etiology MH - *Iliac Artery MH - Kidney Transplantation/*adverse effects MH - Male MH - Middle Aged MH - Peripheral Vascular Diseases/diagnosis/*etiology MH - Renal Artery Obstruction/*etiology MH - Risk Factors EDAT- 1999/09/15 00:00 MHDA- 1999/09/15 00:01 CRDT- 1999/09/15 00:00 PHST- 1999/09/15 00:00 [pubmed] PHST- 1999/09/15 00:01 [medline] PHST- 1999/09/15 00:00 [entrez] AID - 10.1034/j.1399-0012.1999.130412.x [doi] PST - ppublish SO - Clin Transplant. 1999 Aug;13(4):349-55. doi: 10.1034/j.1399-0012.1999.130412.x.