Peripheral Vascular Disease Involving Transplant Renal Artery

BACKGROUND: Transplant renal artery stenosis (TRAS) can afflict up-to one-fifth of patients with a transplanted kidney. It is associated with uncontrolled hypertension, loss of precious transplanted organs, and mortality. Pathophysiology, diagnosis, and treatment of TRAS is distinct from vascular diseases of the native kidney. The value of preservation of a transplanted kidney is unique, considering the emotional and surgical stakes involved. This field lacks large randomized trials, and ethically it may never be possible to randomize patients with a solitary transplanted kidney. Therefore, vascular interventionalists have to rely on treating factors that can cause graft malfunction like uncontrolled hypertension and renal ischemia, considering that sufficiently large, prospective, randomized data indicating that treating these factors make a difference may never emerge.