Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

Table 2

Overview of the protocol strategies (PS) for early detection of TRAS according to the patient’s individual risk category (RC). Patients were defined as symptomatic in case of refractory hypertension (defined as failure to achieve optimal blood pressure control to levels less than 140/90 mm Hg despite the concomitant use of 3 or more different classes of antihypertensive agents) and/or worsening of renal function (defined as rising of serum creatinine >20% of basal value, after excluding all other potential sources of graft impairment). RC1 patients continued PS1, RC2 and RC4 patients followed a stricter follow-up (PS2) to reclassify the patient in a different RC; finally, RC3 and RC 5 patients were candidate for immediate angiography +/− PTA and stenting. TRAS = transplant renal artery stenosis; SPV = systolic peak velocity.

Symptoms; (refractory hypertension and/or worsening of renal function)	VPS; (m/sec)	Risk category; (RC)	Protocol strategy; (PS)
No	<2,2	1	1. Regular ECD follow-up at 3° POD, discharge, 1, 3, 6, 12 months then annually
	2,2–2,8	2	2. ECD imaging monthly until reclassification in a different RC within 1-year period
	>2,8	3	3. Indication for angiography PTA stenting
Yes	<2,2	4	2. ECD imaging monthly until reclassification in a different RC within 1-year period
	>2,2	5	3. Indication for angiography PTA stenting