Post-Transplant Renal Artery Stenosis needing Angioplasty

Abstract

The causes of hypertension refractory to treatment in the post transplant scenario are commonly worsening renal function, renal artery narrowing and antibody mediated rejection. This may be insidious or obvious clinically on followup. It is a cause of considerable morbidity and occasional graft loss.

Nineteen year old female patient underwent related donor renal transplant and had a near normal post operative Doppler study of the renal vessels.

After 4-6 months she presented with headache and hypertension needing upto 4 drugs at a time (on Amlopress, Prazopress XL, Arkamine, Telvas) and with normal urea and creatinine levels. Colour Doppler Ultrasound was done which showed parvus tardus pattern suggestive of renal artery stenosis. CT Angiogram confirmed the narrowing of the renal artery segment. Transplant renal artery DSA demonstrated a tight stenosis just proximal to the arterial bifurcation and an Angioplasty done using a balloon mounted stent. Post operative results were excellent.

The case is reported to highlight the need for early detection, and prompt management to achieve excellent results.