Endovascular intervention is a very effective and durable treatment option for the management of transplant renal dysfunction related to proximal aorto-iliac occlusive disease.
Endovascular intervention (angioplasty and stenting) was technically successful in all 26 included patients with transplant renal dysfunction related to proximal aorto-iliac occlusive disease.
Endovascular intervention was associated with a significant increase in intrarenal resistive index (RI) across all three renal poles after stenting.
Serum creatinine improved significantly following endovascular intervention.
Systolic blood pressure improved significantly one week after endovascular intervention.
Overall estimated transplant kidney survival was 95% at both 5 and 10 years of follow-up.
This research suggests that kidney transplant recipients can develop declining kidney function years after their transplant not because of problems with the transplanted kidney itself, but because of blockages in the large blood vessels (the aorta and iliac arteries) that supply blood to the transplant. In this study of 26 patients, doctors used a minimally invasive procedure called angioplasty and stenting — where a small tube is inserted through the skin to open up the blocked artery — to restore blood flow. The procedure worked successfully in every single patient. After the procedure, kidney function improved substantially: the average creatinine level (a blood marker of kidney health) dropped from 2.29 to 1.49 mg/dL within six weeks, and blood pressure also fell significantly within one week. Ultrasound measurements of blood flow within the transplanted kidney (resistive index) also normalized after stenting, confirming that blood was flowing more effectively to the organ. Remarkably, 95% of the transplanted kidneys were still functioning at both 5 and 10 years after the procedure. This research suggests that proximal aorto-iliac disease should be considered as a cause of late transplant kidney dysfunction, and that endovascular treatment is a highly effective and long-lasting solution when it is identified. It highlights the importance of looking beyond the transplanted kidney itself when evaluating unexplained decline in transplant function, particularly in patients who also have difficult-to-control high blood pressure.
De Vis E, Naesens M, Jochmans I, Claes K, Laenen A, Monbaliu D, et al.. (2026). Late kidney transplant dysfunction related to proximal aorto-iliac occlusive disease.. Transplant international : official journal of the European Society for Organ Transplantation. https://doi.org/10.3389/ti.2026.15946