Ana Carolina Buso Faccinetto, Gustavo Rocha Feitosa Santos, Juliana Cristina Taguchi, Henry Campos Orellana, Attílio Galhardo, Gabriel Kanhouche, Manoela Linhares Machado Barteczko, Hélio Tedesco Júnior, Nathalie Jeanne Magioli Bravo-Valenzuela, Valdir Ambrósio Moises, José Osmar Medina Pestana, Célia Maria Camelo Silva, Adriano Henrique Pereira Barbosa
Abstract
Twenty patients had significant stenosis (>50%) and underwent percutaneous transluminal angioplasty (PTA/stenting) (TRAS group-intervention); 14 TNS (non-significant group -control) patients did not have significant stenosis (≤50%) and were treated clinically. The combined primary endpoints were death from all causes and late graft failure. The secondary endpoints were serum creatinine (SCr), systolic blood pressure (SBP), and diastolic blood pressure (DBP).
Introduction
Transplant renal artery stenosis (TRAS) can lead to hypertension and graft dysfunction [1]. Numerous studies specify percutaneous intervention as the treatment of choice for adult patients with TRAS [2]. TRAS is initially suspected on the basis of refractory hypertension and progressive graft loss in the absence of acute graft failure, calcineurin inhibitor toxicity, or urinary obstruction [3]. Depending on the definition and on the diagnostic techniques used, TRAS commonly manifests between the third month and the second year after transplantation [4].
Materials and method
The Hospital do Rim e Hipertensão is a part of the Universidade Federal de São Paulo (HRIM-UNIFESP), which is in São Paulo (the capital), Brazil, and specializes in kidney transplantation. In this single center has experience in performing kidney transplants in children and adolescents [8,9].
Results
Over a period of 7 years and 11 months, 367 pediatric kidney transplants were performed in the period, 36 children and adolescents (under ≤18 years of age) (Table 1) with suspected TRAS were admitted to the hemodynamics laboratory to undergo angiography for suspected TRAS. Two patients were excluded from the study: they had complex lesions and did not undergo angioplasty. Twenty patients with stenosis >50% underwent the intervention (TRAS group), and 14 patients had stenosis ≤50% (TNS group- control).
Discussion
TRAS is the main vascular complication post transplantation, with a wide range of incidences in the literature depending on the diagnostic method used. The cause of refractory hypertension was especially evident in the TRAS group (intervention) symptom of which it is evidenced as the first cause of graft dysfunction. In our study, all patients were treated with immunosuppressants and received prophylactic therapy for cytomegalovirus, with other causes being excluded.
Conclusions
TRAS treatment with percutaneous intervention may be considered for the pediatric population with TRAS and can plays an important role in the contemporary management of medically refractory hypertension in children and adolescents. Further research long-term studies are required to monitor the progression of renal stenosis in this group of pediatric patients and to better evaluation of the results of treatment with drug-eluting stents.
Citation: Faccinetto ACB, Santos GRF, Taguchi JC, Orellana HC, Galhardo A, Kanhouche G, et al. (2024) Retrospective analysis of percutaneous intervention of the renal artery in transplanted kidneys in children and adolescents at a tertiary public hospital. PLoS ONE 19(3): e0297975. https://doi.org/10.1371/journal.pone.0297975
Editor: Eyüp Serhat Çalık, Ataturk University Faculty of Medicine, TURKEY
Received: April 25, 2023; Accepted: January 15, 2024; Published: March 29, 2024
Copyright: © 2024 Faccinetto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The statistical analyses results are provided in the article. The data supporting the findings of this study i.e. the demographic, clinical, and follow-up data of patients who underwent angiography of the transplanted renal artery were collected directly from medical records and cannot be shared publicly. Procedure data, success rates, and complications were recorded in the REDCap database of our catheterization laboratory. All patient data were de-identified to ensure privacy and confidentiality. For data requests, please contact the Ethics Committee of the Federal University of São Paulo (email: cep@unifesp.br).
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297975#sec016
