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      Endovascular stenting with a drug-eluting stent of transplanted renal artery stenosis in a dual kidney transplanted patient Translated title: Tratamento endovascular com stent farmacológico em estenose de artéria renal transplantada de paciente com transplante renal duplo

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          Abstract

          Renal transplant remains the preferred therapy for end-stage renal disease (ESRD). Given the shortage of suitable donor kidneys, use of an expanded criteria donor (ECD) allows marginal kidneys to be transplanted; albeit at risk of increased graft failure due to lower nephron mass. To reduce the risk of graft failure, double kidney transplant (DKT) is advocated, with favorable outcomes. Transplant renal artery stenosis (TRAS) is one of the most common vascular complications following renal transplant. Unlike single kidney transplants, where TRAS usually presents with fluid overload, uncontrolled hypertension, and worsening kidney functions; it may be clinically silent in DKT patients since they have two functional transplanted kidneys. We hereby report a case of TRAS in a DKT patient who had 2 years of favorable clinical outcomes following successful endovascular stenting. He however recently died of COVID-19 associated pneumonitis.

          Resumo

          O transplante renal continua sendo a terapia preferida para doenças renais em fase terminal. Dada a escassez de rins de doadores adequados, o doador com critérios expandidos permite que rins marginais sejam transplantados, embora haja um maior risco de falha do enxerto devido à diminuição da massa nefrótica. Para diminuir o risco de falha do enxerto, recomenda-se o transplante renal duplo (TRD), com resultados favoráveis. A estenose de artéria renal transplantada (EART) é uma das complicações vasculares mais comuns após o transplante renal. Ao contrário dos transplantes de rim simples, nos quais a EART geralmente se manifesta como sobrecarga de fluido, hipertensão descontrolada e piora das funções renais, ela pode ser clinicamente silenciosa em pacientes com TRD, pois eles têm dois rins funcionais transplantados. Relatamos aqui um caso de EART em um paciente com TRD que teve resultados clínicos favoráveis por dois anos após o sucesso do implante de stent endovascular. No entanto, ele morreu recentemente de pneumonite associada à covid-19.

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          STUDIES ON EXPERIMENTAL HYPERTENSION

          These experiments indicate that, in dogs at least, ischemia localized to the kidneys is a sufficient condition for the production of persistently elevated systolic blood pressure. When the constriction of both main renal arteries is made only moderately severe in the beginning, the elevation of systolic blood pressure is unaccompanied by signs of materially decreased renal function. In this respect the hypertension in these animals resembles the hypertension which is associated with so called benign nephrosclerosis in man. Subsequent increase of the constriction of the main renal arteries does not materially damage renal function, probably because of adequate development of accessory circulation. More delicate methods for detecting a change may yet prove that some damage does occur. Almost complete constriction of both main renal arteries, from the beginning, results in great elevation of systolic blood pressure which is accompanied by severe disturbance of renal function and uremia. This resembles the type of hypertension which is associated with so called malignant nephrosclerosis, in the sense of Fahr (17). In several of the animals with persistent elevation of systolic blood pressure, anatomical changes were observed in the glomeruli, vessels and parenchyma of the kidneys which are most probably directly referable to the ischemia. It is hoped that these investigations will afford a means of studying the pathogenesis of hypertension that is associated with renal vascular disease.
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            Expanded criteria donors for kidney transplantation.

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              Improved graft survival after renal transplantation in the United States, 1988 to 1996.

              The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the long-term survival of kidney transplants is not known. We analyzed the influence of demographic characteristics (age, sex, and race), transplant-related variables (living or cadaveric donor, panel-reactive antibody titer, extent of HLA matching, and cold-ischemia time), and post-transplantation variables (presence or absence of acute rejection, delayed graft function, and therapy with mycophenolate mofetil and tacrolimus) on graft survival for all 93,934 renal transplantations performed in the United States between 1988 and 1996. A regression analysis adjusted for these variables was used to estimate the risk of graft failure within the first year and more than one year after transplantation. From 1988 to 1996, the one-year survival rate for grafts from living donors increased from 88.8 to 93.9 percent, and the rate for cadaveric grafts increased from 75.7 to 87.7 percent. The half-life for grafts from living donors increased steadily from 12.7 to 21.6 years, and that for cadaveric grafts increased from 7.9 to 13.8 years. After censoring of data for patients who died with functioning grafts, the half-life for grafts from living donors increased from 16.9 years to 35.9 years, and that for cadaveric grafts increased from 11.0 years to 19.5 years. The average yearly reduction in the relative hazard of graft failure after one year was 4.2 percent for all recipients (P<0.001), 0.4 percent for those who had acute rejection (P=0.57), and 6.3 percent for those who did not have acute rejection (P<0.001). Since 1988, there has been a substantial increase in short-term and long-term survival of kidney grafts from both living and cadaveric donors.
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                Author and article information

                Journal
                J Vasc Bras
                J Vasc Bras
                jvb
                Jornal Vascular Brasileiro
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                1677-5449
                1677-7301
                29 November 2021
                2021
                : 20
                : e20210054
                Affiliations
                [1 ] originalPost Graduate Institute of Medical Education and Research – PGIMER, Chandigarh, India.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                Correspondence Rajesh Vijayvergiya Post Graduate Institute of Medical Education & Research, Advanced Cardiac Centre, Department of Cardiology, Sector 12 160 012 - Chandigarh, India Tel.: +91 172 275 6218 E-mail: rajeshvijay999@ 123456hotmail.com

                Author information: RV - PhD degree in Cardiology; Professor, Department of Cardiology, PGIMER. NK - MD degree in Internal Medicine; Senior resident, Department of Cardiology, PGIMER. GK - PhD degree in Cardiology; Senior Research Associate, Department of Cardiology, PGIMER. AS - MCh degree in Surgery; Professor, Department of Renal Transplant Surgery, PGIMER. AL - MD degree in Radio-diagnosis; Professor, Department of Radiology, PGIMER. AhS - MD degree in Nuclear Medicine; Professor, Department of Nuclear Medicine, PGIMER.

                Author contributions Conception and design: RV, NK, GK, AS, AL, AhS Analysis and interpretation: RV, NK, GK, AS, AL, AhS Data collection: RV, NK, GK, AS, AL, AhS Writing the article: RV, NK, GK, AS, AL, AhS Critical revision of the article: RV, NK, GK, AS, AL, AhS Final approval of the article*: RV, NK, GK, AS, AL, AhS Statistical analysis: RV, NK, GK Overall responsibility: RV *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Author information
                http://orcid.org/0000-0001-5250-4735
                Article
                jvbRC20210054_EN 00634
                10.1590/1677-5449.210054
                8668082
                c4e26507-b2a8-4dc3-ae4b-8d4f0e7c78fa
                Copyright© 2021 The authors.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 April 2021
                : 17 August 2021
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 20
                Categories
                Case Report

                double kidney transplant,drug-eluting stent,end-stage renal disease,expanded criteria donor,percutaneous transluminal renal angioplasty,transplant renal artery stenosis,transplante renal duplo,stent farmacológico,doença renal em fase terminal,doador com critérios expandidos,angioplastia percutânea transluminal em artéria renal,estenose de artéria renal transplantada

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