In some centers and especially in Europe, renal clearances are performed serially to evaluate renal function. These are performed less frequently in the United States. Numerous quantitative indexes are used to evaluate transplants. Although no single parameter has achieved acceptance, it appears that they may be useful. Tc-99m diethylenetriamine pentaacetic acid (DTPA) or Tc-99m mercaptoacetyltriglycine (MAG3) can be used to follow the transplant. Because of its higher extraction fraction and better image quality, MAG3 is preferred at most transplant centers. DTPA, which is not excreted, is limited in the evaluation for obstruction, only demonstrating early impact on glomerular filtration. In a limited number of studies, MAG3 has not been proven superior to DTPA [67]. Angiography RAS is reported to occur in 1% to 23% of patients following transplantation and accounts for 1% to 5% of renal transplant hypertension [26,71,72]. Percutaneous therapeutic angioplasty (PTA) and stenting (PTAS) is the treatment of choice for RAS, with a success rate of 65% to 100% [73-84]. The complication rate from PTA and PTAS of 0% to 10% is low compared to surgery, which has a graft loss rate of 15% and mortality rate of 5%. Renal Transplant Dysfunction However, in 1 long-term study over a 24-year period, Peregrin et al [80] found a higher complication rate of 25.5% (usually without clinical sequelae). The majority of these complications were related to arterial access. In a study of 44 patients by Ghazanfar et al [76], the technical success rate of PTA was 100% and the 5-year graft survival rate was 86%. The restenosis rate after PTA has been reported to be between 10% and 56% [85]. Pappas et al [79] found a technical success rate of 100% with no acute complications, amelioration of arterial hypertension, and improvement of graft function within 7 postoperative days following PTAS.
Renal Transplant Dysfunction. In some centers and especially in Europe, renal clearances are performed serially to evaluate renal function. These are performed less frequently in the United States. Numerous quantitative indexes are used to evaluate transplants. Although no single parameter has achieved acceptance, it appears that they may be useful. Tc-99m diethylenetriamine pentaacetic acid (DTPA) or Tc-99m mercaptoacetyltriglycine (MAG3) can be used to follow the transplant. Because of its higher extraction fraction and better image quality, MAG3 is preferred at most transplant centers. DTPA, which is not excreted, is limited in the evaluation for obstruction, only demonstrating early impact on glomerular filtration. In a limited number of studies, MAG3 has not been proven superior to DTPA [67]. Angiography RAS is reported to occur in 1% to 23% of patients following transplantation and accounts for 1% to 5% of renal transplant hypertension [26,71,72]. Percutaneous therapeutic angioplasty (PTA) and stenting (PTAS) is the treatment of choice for RAS, with a success rate of 65% to 100% [73-84]. The complication rate from PTA and PTAS of 0% to 10% is low compared to surgery, which has a graft loss rate of 15% and mortality rate of 5%. Renal Transplant Dysfunction However, in 1 long-term study over a 24-year period, Peregrin et al [80] found a higher complication rate of 25.5% (usually without clinical sequelae). The majority of these complications were related to arterial access. In a study of 44 patients by Ghazanfar et al [76], the technical success rate of PTA was 100% and the 5-year graft survival rate was 86%. The restenosis rate after PTA has been reported to be between 10% and 56% [85]. Pappas et al [79] found a technical success rate of 100% with no acute complications, amelioration of arterial hypertension, and improvement of graft function within 7 postoperative days following PTAS.