Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors: Incidence, timing, and role of ultrasound in screening

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Abstract

In previous studies with different donor selection criteria and noncontemporary surgical techniques, graft arterial stenosis (GAS) has been reported to occur more frequently in adult recipients of pediatric en bloc renal allografts (EBKT) as compared to single adult donor allografts. The purpose of our study was to evaluate the incidence of GAS within our EBKT recipient population and to evaluate clinical and imaging features of those cases with GAS. In a retrospective cohort study, we analyzed 182 EBKT performed at a single institution. We identified cases of suspected GAS based on clinical factors, lab results, and noninvasive imaging. Diagnosis of GAS was confirmed by digital subtraction angiography. Two EBKT recipients (1.1% of 182) had angiographically confirmed GAS at 2.5 and 4.5 months after transplant. In both cases, the stenoses were short segment within the proximal (perianastomotic) donor aorta, color Doppler ultrasound demonstrated peak systolic velocities of >400-cm/s, and poststenotic parvus tardus waveforms were present. Both patients underwent angioplasty and demonstrated postintervention improvement in renal function and blood pressure. Restenosis did not occur during follow up. In conclusion, recipients of EBKT have a low incidence of GAS, similar to the lowest reported for adult single allografts. The authors perform a retrospective analysis of recipients of pediatric kidney en bloc grafts for graft arterial stenosis to determine the incidence of stenosis in this population as well as the role of ultrasound in its diagnosis.

Original languageEnglish (US)
Pages (from-to)2940-2946
Number of pages7
JournalAmerican Journal of Transplantation
Volume15
Issue number11
DOIs
StatePublished - Nov 1 2015

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Pathologic Constriction
Tissue Donors
Pediatrics
Transplants
Kidney
Incidence
Allografts
Donor Selection
Doppler Ultrasonography
Digital Subtraction Angiography
Angioplasty
Patient Selection
Population
Aorta
Cohort Studies
Retrospective Studies
Color
Blood Pressure

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

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title = "Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors: Incidence, timing, and role of ultrasound in screening",
abstract = "In previous studies with different donor selection criteria and noncontemporary surgical techniques, graft arterial stenosis (GAS) has been reported to occur more frequently in adult recipients of pediatric en bloc renal allografts (EBKT) as compared to single adult donor allografts. The purpose of our study was to evaluate the incidence of GAS within our EBKT recipient population and to evaluate clinical and imaging features of those cases with GAS. In a retrospective cohort study, we analyzed 182 EBKT performed at a single institution. We identified cases of suspected GAS based on clinical factors, lab results, and noninvasive imaging. Diagnosis of GAS was confirmed by digital subtraction angiography. Two EBKT recipients (1.1{\%} of 182) had angiographically confirmed GAS at 2.5 and 4.5 months after transplant. In both cases, the stenoses were short segment within the proximal (perianastomotic) donor aorta, color Doppler ultrasound demonstrated peak systolic velocities of >400-cm/s, and poststenotic parvus tardus waveforms were present. Both patients underwent angioplasty and demonstrated postintervention improvement in renal function and blood pressure. Restenosis did not occur during follow up. In conclusion, recipients of EBKT have a low incidence of GAS, similar to the lowest reported for adult single allografts. The authors perform a retrospective analysis of recipients of pediatric kidney en bloc grafts for graft arterial stenosis to determine the incidence of stenosis in this population as well as the role of ultrasound in its diagnosis.",
author = "C. Bent and Ghaneh Fananapazir and G. Tse and Corwin, {Michael T} and Vu, {Catherine T} and Chandrase Santhanakrishnan and Perez, {Richard V} and Christoph Troppmann",
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T1 - Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors

T2 - Incidence, timing, and role of ultrasound in screening

AU - Bent, C.

AU - Fananapazir, Ghaneh

AU - Tse, G.

AU - Corwin, Michael T

AU - Vu, Catherine T

AU - Santhanakrishnan, Chandrase

AU - Perez, Richard V

AU - Troppmann, Christoph

PY - 2015/11/1

Y1 - 2015/11/1

N2 - In previous studies with different donor selection criteria and noncontemporary surgical techniques, graft arterial stenosis (GAS) has been reported to occur more frequently in adult recipients of pediatric en bloc renal allografts (EBKT) as compared to single adult donor allografts. The purpose of our study was to evaluate the incidence of GAS within our EBKT recipient population and to evaluate clinical and imaging features of those cases with GAS. In a retrospective cohort study, we analyzed 182 EBKT performed at a single institution. We identified cases of suspected GAS based on clinical factors, lab results, and noninvasive imaging. Diagnosis of GAS was confirmed by digital subtraction angiography. Two EBKT recipients (1.1% of 182) had angiographically confirmed GAS at 2.5 and 4.5 months after transplant. In both cases, the stenoses were short segment within the proximal (perianastomotic) donor aorta, color Doppler ultrasound demonstrated peak systolic velocities of >400-cm/s, and poststenotic parvus tardus waveforms were present. Both patients underwent angioplasty and demonstrated postintervention improvement in renal function and blood pressure. Restenosis did not occur during follow up. In conclusion, recipients of EBKT have a low incidence of GAS, similar to the lowest reported for adult single allografts. The authors perform a retrospective analysis of recipients of pediatric kidney en bloc grafts for graft arterial stenosis to determine the incidence of stenosis in this population as well as the role of ultrasound in its diagnosis.

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