Safety and efficacy of endovascular interventions on transplant renal vessels within the 30-day perioperative period

Abstract

Abstract Background: Vascular complications following recent renal transplantation causes a significant incidence of sub-optimal graft outcomes. These range from delayed graft function and resistant hypertension to early graft loss. Early endovascular intervention is largely avoided as it is perceived as high risk to the new vascular anastomosis. However, surgical intervention in this setting is technically challenging and associated with poor outcomes. The aim of this study is to evaluate technical and clinical outcomes after endovascular intervention within the first 30 days. Materials and Methods: All radiological interventions performed on transplant renal vessels within the 30-day perioperative period from April 2007 to December 2022 were assessed. The patient’s electronic notes, radiological reports and blood results were reviewed retrospectively. Parameters such as angiographic diagnosis, complications, procedure outcomes and serum creatinine levels before and after intervention were analysed. Results: 39 early transplant renal endovascular procedures were performed in our institution. The mean endovascular intervention time after transplantation was 12 days (range 1-30 days). Vascular pathology included transplant renal artery stenosis (n=21), renal venous stenosis (n=5), pseudoaneurysm (n=2), thrombosed renal artery (n=1), occluded renal vein with subcapsular haematoma (n=1), segmental arterial bleeding (n=1), common iliac artery stenosis (n=1) and subcortical arteriovenous fistula (n=1). Six cases did not demonstrate any significant vascular pathology. Endovascular stenting (n=14), percutaneous transluminal angioplasty only (n=10), angiography only (n=11) and embolisation (n=4) were performed with a technical success rate of 90%. Complications occurred in six cases (arterial dissection, thromboembolism and arterial spasm). However, they were either not significant or they were successfully treated and did not lead to graft functional decline. Only two cases proceeded to surgical exploration for anastomotic reconstruction and haematoma evacuation. Seven transplants failed within a year from the endovascular intervention. For those that had endovascular treatment, there was a significant decrease in serum creatinine levels post-procedure with a mean difference of 96.5 ± 26.8 µmol/L (p=0.002; n=22) at 1 week and 235.2 ± 42.3 µmol/L (p=0.0001; n=22) at 1 month. Conclusion: Endovascular intervention in newly transplanted kidneys is a safe and less invasive option which avoids the morbidity of open surgery. When used selectively, it has good therapeutic outcomes and can significantly improve graft function.