A Case Report of Angioplasty and Successful Stent Placement in Treatment of Transplanted Renal Artery Stenosis

Renal transplantation has established itself as the treatment of choice for the majority of patients with End stage renal failure(ESRF). Arterial stenosis is the most common vascular complication after kidney transplantation, occurring in approximately 4%-25% of transplant recipients. Case Report: The patient is a 68 year old man with ESRF due to Poly cystic kidney disease(PCKD) that was treated by renal transplantation from a living donor. Vascular anastomosis was end to end from renal artery to right internal iliac artery. After 1.5 month from transplantation, serum creatinine(Cr) raised to 3.1. In color duplex ultrasound Resistance index(RI) in intra renal arteries and spectral wave form in intratenal, renal and internal iliac arteries indicated severe stenosis in internal iliac artery proximal to anastomosis. Magnetic resonance angiography(MRA) shows stenosis of about 80%-90% in internal iliac artery proximal to anastomosis. Radionuclide scan with TC-DTPA suggests mild hydronephrosis & renal dysfunction, so for this patient PTA was performed. 24 hours after stent placement, serum Cr decreased to 2.1. In color Doppler ultrasound, 48 hours after stent placement, wavefrom, time and resistance indices are in normal range. Radionuclide scan 3 days after angioplasty demonstrated normal renal function. Important notes about this case were, short time(1.5 month) from transplant to presentation of symptoms of arterial stenosis, arterial stenosis proximal to anastomosis in internal iliac artery, and stenosis following transplantation from a living donor. Because of successful PTA in this case, stent placement is suggested as an effective and useful treatment for arterial stenosis after renal transplantation.