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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Transplant renal artery stenosis is an important complication that causes arterial hypertension&#44; deteriorating renal function&#44; and even renal graft loss&#44; and has an incidence rate of 1&#37;-23&#37;&#46;<span class="elsevierStyleSup">1-3</span> This condition usually arises during the first few years following transplantation&#46;<span class="elsevierStyleSup">1&#44;2</span> The diagnosis is suspected based on Doppler ultrasound images while renal arteriography continues to be the gold standard for diagnostic confirmation and treatment&#44; since this procedure facilitates angioplasty and stent placement all in the same intervention&#46;</p><p class="elsevierStylePara">Until now&#44; no randomised clinical trials have been carried out to establish whether endovascular treatment produces superior results to surgery&#46; On the other hand&#44; there is also debate regarding the effects of medical treatment or angioplasty with stent placement on blood pressure and renal graft function&#46;</p><p class="elsevierStylePara">The aim of our study was to analyse the evolution of kidney transplant recipients with graft artery stenosis undergoing percutaneous transluminal angioplasty and stent placement&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We performed a prospective observational study of 13 patients with kidney transplants diagnosed with renal allograft artery stenosis who were treated with angioplasty and stent placement&#46; Mean age was 54 years &#40;range&#58; 29-73 years&#41;&#59; 11 patients were men and 2 women&#46;</p><p class="elsevierStylePara">The mean post-kidney transplant time was 180 months &#40;range&#58; 7-1260 months&#41;&#44; 6 patients had early stenosis &#40;&#60;2 weeks following transplantation&#41;&#44; 6 patients developed stenosis during the first year following transplantation &#40;range&#58; 54-240 days&#41;&#44; and 1 patient had late stenosis &#40;3 and a half years following transplantation&#41;&#46; The clinical suspicion of stenosis was based on deteriorated renal function accompanied by elevated blood pressure in some cases&#44; and a Doppler ultrasound analysis of the renal artery compatible with the diagnosis of stenosis&#46; All patients were under immunosuppression treatment with prednisone&#44; tacrolimus&#44; and mycophenolic acid&#46; The stents had a mean length of 17&#46;7mm &#40;range&#58; 12-24mm&#41; and a mean diameter of 5&#46;3mm &#40;range&#58; 5-6mm&#41;&#46; After the procedure&#44; patients received follow-up treatment with 100mg of acetyl-salicylic acid indefinitely and 75mg of clopidogrel during the first month&#46;</p><p class="elsevierStylePara">We evaluated clinical variables &#40;family history&#44; tobacco use&#44; hypertension&#44; diabetes&#44; dyslipidaemia&#44; cardiovascular diseases&#44; aetiology of the chronic kidney disease&#41;&#44; reason for arteriography&#44; number and location of lesions observed&#44; and patient evolution following treatment &#40;renal function&#44; blood pressure&#44; number of anti-hypertensive drugs&#41;&#46; The results are expressed as mean and standard deviation&#46; We compared means using Student&#8217;s t-tests&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our patients had multiple cardiovascular risk factors &#40;12 arterial hypertension&#44; 6 dyslipidaemia&#44; 4 diabetes&#44; 2 tobacco use&#41; and 4 suffered a cardiovascular event&#46; Arterial stenosis was suspected in light of deteriorating renal function in 11 patients&#44; and due to arterial hypertension in 2&#46;</p><p class="elsevierStylePara">Doppler ultrasound revealed type 3 waves in 9 patients and type 2 waves in 4 cases&#46; The stenosis was located in the ostium in 8 patients and in the proximal third of the renal artery in 5 patients&#46;</p><p class="elsevierStylePara">The stenosis was resolved by radiological intervention in all 13 cases&#44; with the only complication being one case of haematoma at the puncture site&#44; which resolved spontaneously&#46;</p><p class="elsevierStylePara">Table 1 shows the overall evolution of patients following the procedure&#46; We observed a progressive improvement in renal function during the first 3 months&#44; which remained stable during the following two years&#46; Blood pressure levels also improved over the two-year period&#44; and the mean number of anti-hypertensive drugs administered also remained stable &#40;2&#46;5 drugs per patient&#41;&#46; Figure 1 displays the evolution of renal function for each patient&#46;</p><p class="elsevierStylePara">There were no long-term complications from the procedure&#46; One patient died 8 months after transplantation due to invasive pulmonary disease caused by cytomegalovirus&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The most important finding in this study was the technical and functional success of the procedure&#44; with improved renal function and control of blood pressure following angioplasty and stent placement in transplant renal artery stenosis&#44; with no long-term complications&#46; Almost half of the procedures were carried out within two weeks of transplantation&#44; which has not been reported before in the medical literature&#46;</p><p class="elsevierStylePara">Post-transplantation vascular complications are rare&#44; but very important&#44; since they may cause allograft dysfunction and loss&#46; The aetiology of stenosis is multifactorial&#44; including reduced vessel diameter and atherosclerosis in the donor artery&#44; trauma in the donor artery during removal of the organ or in the recipient&#8217;s artery during surgery&#44; the suturing technique used&#44; and damage to the iliac artery during transplantation&#46;</p><p class="elsevierStylePara">Our results contrast with those from the ASTRAL study<span class="elsevierStyleSup">4</span> of patients with renal artery stenosis in native kidneys&#46; They found no evidence of a clinical benefit following revascularisation in patients with renovascular atherosclerotic disease&#46; In our study&#44; stenoses occurred during the first year following transplantation &#40;within the first 2 weeks in half of all cases&#41; and they were found in the ostium in 8 cases&#44; which suggests that the surgical procedure itself plays a very important role in the aetiology of the condition&#44; both because of the quality of the vessels in expanded criteria donor kidneys and the length of the vessels in living donor kidneys removed by laparoscopy&#46;</p><p class="elsevierStylePara">Several studies have also shown the benefit of percutaneous interventions in transplant renal artery stenosis&#46;<span class="elsevierStyleSup">5-7</span> These studies had small sample sizes&#44; with 10-24 patients and a short follow-up period&#44; and therefore lack statistical consistency&#46; One of these studies demonstrated significantly improved renal function and blood pressure values only one week after the procedure&#46; Recently&#44; a study involving angioplasty without stent placement in 44 patients reported improved allograft survival after 5 years&#44; as compared to patients that underwent surgery or conservative medical treatment&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">On the other hand&#44; a study performed in 43 patients failed to demonstrate any benefits of angioplasty during a 5-year follow-up period&#44;<span class="elsevierStyleSup">9</span> and another study involving 18 patients treated with angioplasty showed a decrease in mean blood pressure of 7&#46;3mm Hg&#44; with no improvements in glomerular filtration rates after 6 months&#46; In our study&#44; systolic blood pressure dropped by a mean 20mm Hg and diastolic blood pressure by a mean 14mm Hg one year after the procedure&#46;</p><p class="elsevierStylePara">The use of transluminal percutaneous angioplasty without stent placement has been associated with re-stenosis rates of 16&#37;-62&#37; according to some studies&#44; while the same procedure with stent placement caused a re-stenosis rate less than 10&#37;&#46;<span class="elsevierStyleSup">5</span> In our study&#44; we did not observe any cases of re-stenosis&#44; although we were unable to compare our results with a non-stent control group&#46;</p><p class="elsevierStylePara">Some studies have described acute complication rates of 5&#37;&#44;<span class="elsevierStyleSup">11</span> but only one early complication arose in our study&#58; a haematoma at the puncture site&#46; It was quickly resolved through conservative treatment and caused no long-term complications&#46;</p><p class="elsevierStylePara">In conclusion&#44; our study suggests that correcting transplant renal artery stenosis using percutaneous transluminal angioplasty and stent placement is an effective and safe procedure&#44; improving glomerular filtration rates and blood pressure values&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span><span class="elsevierStyleBold"></span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11080&#95;16025&#95;31456&#95;en&#95;t1&#95;11080&#46;jpg" class="elsevierStyleCrossRefs"><img src="11080_16025_31456_en_t1_11080.jpg" alt="Evolution of renal function and blood pressure following angioplasty and stent placement"></img></a></p><p class="elsevierStylePara">Table 1&#46; Evolution of renal function and blood pressure following angioplasty and stent placement</p><p class="elsevierStylePara"><a href="grande&#47;11080&#95;16025&#95;31457&#95;en&#95;f1&#95;110802&#46;jpg" class="elsevierStyleCrossRefs"><img src="11080_16025_31457_en_f1_110802.jpg" alt="Progression of individual renal function"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Progression of individual renal function</p>"
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        "resumen" => "<p class="elsevierStylePara">La estenosis arterial del injerto renal es una complicaci&#243;n que requiere&#44; en ocasiones&#44; un abordaje terap&#233;utico con cirug&#237;a o angioplastia&#46; El objetivo del presente estudio es analizar la evoluci&#243;n de 13 pacientes trasplantados renales con estenosis arterial del injerto tratados mediante angioplastia y colocaci&#243;n de <span class="elsevierStyleItalic">stent</span>&#46; La sospecha cl&#237;nica se fundament&#243; en un deterioro de funci&#243;n renal&#44; acompa&#241;ado de mal control de la presi&#243;n arterial en algunos casos&#44; con ecograf&#237;a <span class="elsevierStyleItalic">doppler</span> compatible&#46; Se realiz&#243; una arteriograf&#237;a que confirm&#243; el diagn&#243;stico y en el mismo acto se realiz&#243; una angioplastia con colocaci&#243;n de <span class="elsevierStyleItalic">stent</span>&#46; Se objetiv&#243; una mejor&#237;a progresiva de la funci&#243;n renal durante los 3 primeros meses que permaneci&#243; estable durante los dos primeros a&#241;os&#46; Por otro lado&#44; mejoraron las cifras de presi&#243;n arterial en los dos primeros a&#241;os&#44; manteniendo el mismo tratamiento antihipertensivo&#46; En conclusi&#243;n&#44; la angioplastia con colocaci&#243;n de <span class="elsevierStyleItalic">stent</span> es un procedimiento efectivo y seguro en el tratamiento de la estenosis de la arteria del injerto renal&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Transplant renal artery stenosis is a major complication that requires a therapeutic approach involving surgery or angioplasty&#46; The aim of this study was to analyse the evolution of renal transplant patients with renal allograft artery stenosis treated by angioplasty and stent placement&#46; Thirteen patients were diagnosed with transplant renal artery stenosis&#46; Clinical suspicion was based on deterioration of renal function and&#47;or poorly controlled hypertension with compatible Doppler ultrasound findings&#46; The diagnosis was confirmed by arteriography&#44; performing an angioplasty with stent placement during the same operation&#46; A progressive improvement in renal function was observed during the first 3 months after the angioplasty&#44; and renal function then remained stable over 2 years&#46; In addition&#44; blood pressure improved during the first 2 years&#44; and as a consequence there was no need to increase the average number of anti-hypertensive drugs administered &#40;2&#46;5 drugs per patient&#41;&#46; In conclusion&#44; angioplasty with stent placement is a safe and effective procedure for the treatment of transplant renal artery stenosis&#46;</p>"
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