移植肾动脉狭窄病因及介入治疗疗效分析

目的探讨移植肾动脉狭窄(TRAS)的病因、介入治疗的疗效及安全性。方法对2000年至2005年经移植肾动脉造影确诊为TRAS的23例患者的临床资料进行回顾性分析。男19例,女4例。年龄23～62岁,平均44岁。23例术后均采用环孢素(CsA)或他克莫司(FK506)加吗替麦考酚酯(MMF)加泼尼松(Pred)三联免疫抑制治疗,其中以CsA治疗为主者14例(60.9%),以FK506治疗为主者9例(39.1%)。结果23例TRAS患者中发生急性排斥反应(AR)者13例(56.5%);移植肾功能延迟恢复(DGF)者4例(17.4%);吻合技术原因致吻合口狭窄者1例(4.3%),移植术后1周切除移植肾,再次移植成功;TRAS原因不明者5例(21.7%)。经造影确诊为移植肾动脉狭窄时间为移植术后1周～4年,平均(12±11)个月。单纯吻合口狭窄12例,单纯主干狭窄9例,吻合口并主干狭窄1例,吻合口并受体髂动脉狭窄1例。22例经介入治疗,13例(59.1%)肾功能于1周内恢复,8例(36.4%)2～3周内恢复,1例(4.5%)随访3个月肾功能无变化;造影剂肾毒性导致血肌酐一过性升高者5例,发生移植肾动脉血栓和腹股沟血肿各1例。结论同种异体肾移植术后TRAS与移植肾血管吻合技术、AR及DGF有关。移植肾动脉造影是确诊金标准,一经确诊应立即行球囊扩张或血管内支架治疗,注意并发症的发生。     

移植肾动脉狭窄诊断及介入治疗效果评价

目的比较肾移植术后移植肾动脉狭窄(TRAS)不同诊断方法的价值并总结血管内介入治疗经验。方法回顾性分析2010年1月至2017年6月武汉大学人民医院器官移植科25例肾移植术后发生TRAS受者临床资料。所有受者均行移植肾彩色多普勒血流显像(CDFI)、磁共振血管成像(MRA)、移植肾数字减影血管造影(DSA)检查。TRAS经DSA确诊后立即行介入治疗,轻度狭窄受者术中予球囊扩张,中、重度狭窄受者根据球囊扩张后的狭窄段管径及长度植入合适动脉支架。根据移植肾动脉峰值流速(PSV)将TRAS受者分为高速血流组(PSV120 cm/s)和低速血流组(PSV50 cm/s),比较两组介入治疗前后移植肾动脉平均PSV和阻力指数。采用Fisher确切概率法比较CDFI与MRA对TRAS确诊率;采用配对t检验比较受者介入治疗前后24 h尿量、平均动脉压、血清肌酐、肾小球滤过率(GFR),采用配对t检验比较高速血流组和低速血流组平均PSV、阻力指数。P0.05为差异有统计学意义。结果 CDFI与MRA对TRAS确诊率分别为68%(17/25)、84.0%(21/25),差异无统计学意义(P=0.57)。DSA检查示轻、中、重度狭窄分别为7、13、5例。7例轻度狭窄受者均予术中球囊扩张;2例肾动脉主干近端及远端两处狭窄受者(重度狭窄)、1例肾动脉及1支副肾动脉均狭窄受者(重度狭窄)术中接受球囊扩张后再植入2根动脉支架;1例肾动脉及2支副肾动脉均狭窄受者(重度狭窄)术中接受球囊扩张后再植入3根动脉支架;余14例受者(中度狭窄13例、重度狭窄1例)术中接受球囊扩张后再植入1根动脉支架。介入治疗前后24 h尿量、平均动脉压、血清肌酐和GFR分别为(1 956±615)和(2 752±729)m L、(117±13)和(96±8)mm Hg(1 mm Hg=0.133 k Pa)、(190±50)和(109±22)μmol/L、(39±12)和(66±8)m L/min,差异均有统计学意义(t=4.17、6.59、7.35、9.48,P均0.05)。17例高速血流组介入治疗前后肾动脉平均PSV、阻力指数分别为(151±27)和(87±28)cm/s、(0.77±0.05)和(0.56±0.06),差异均有统计学意义(t=6.35、4.38,P均0.05);8例低速血流组介入治疗前后肾动脉平均PSV、阻力指数分别为(39±9)和(80±16)cm/s、0.56±0.06和0.66±0.04,差异均有统计学意义(t=6.33、3.92,P均0.05)。截至2017年10月,随访时间4~36个月,25例TRAS受者介入治疗后未见动脉血栓、再狭窄等并发症;介入治疗后分别各有1例出现上消化道出血、移植侧髂外静脉血栓,经治疗后均好转;1例于介入治疗后第3天出现肺部感染,1个月后因呼吸衰竭死亡。结论 MRA与CDFI对于TRAS的诊断价值相似,介入治疗可明显改善TRAS患者相关症状,有效恢复其肾脏血流灌注、改善肾脏功能。     

移植肾早期动脉狭窄的介入治疗及预后观察

移植肾动脉狭窄(TRAS)可发生于肾移植术后任何时期,以术后早期较多,多与外科操作相关[1],如不及时处理,可出现移植肾功能不可逆损伤,乃至出现早期肾功能不全.目前介入治疗已成为大多数TRAS的首选治疗手段.我院2003年3月至2009年4月对8例早期TRAS患者进行介入治疗,近期及远期疗效较佳,特将诊治体会报告如下.     

肾动脉狭窄的介入治疗分析

目的 分析介入治疗肾动脉狭窄（RAS）的疗效。方法自2003年3月至2008年3月共收治45例RAS患者,53支肾动脉中单纯行腔内球囊扩张术（PTA）治疗11支,行球囊扩张及内置支架术（PTA／Stent）治疗者42支,随访9～48个月,检测患者的血压与血肌酐水平,并作肾动脉彩超。结果手术成功率为100％。手术后高血压治愈者9例,改善28例,肾功能改善12例。肌纤维发育不良及多发性大动脉炎的血压改善有效率均为100％,高于动脉粥样硬化的有效率65．1％（P〈0．05）。行彩色多普勒超声检查肾动脉18支,发现再狭窄者7支。结论PTA和PTMStent治疗肾动脉狭窄具有微创、安全、有效的优点。     

药物涂层球囊治疗下肢动脉支架内再狭窄的疗效与安全性

目的 探讨药物涂层球囊治疗下肢动脉支架内再狭窄的疗效与安全性。方法 收集2019年5月至2022年8月于北京小汤山医院接受治疗的76例下肢动脉支架内再狭窄患者的临床资料,按照是否使用药物涂层球囊将其分为治疗组（n=36）和对照组（n=40）。比较两组患者不同时间（术前、术后6个月）的踝肱指数、靶病变管腔狭窄程度、靶病变管腔内径,统计两组患者术后6个月时的管腔通畅率及安全性指标。结果 两组患者均成功进行球囊扩张,即刻手术成功率均为100%,围手术期及住院期间均未发生出血、过敏、死亡等不良事件。术后6个月,治疗组患者靶病变血管通畅率为97.2%(35/36),明显高于对照组的75.0%(30/40),差异有统计学意义（P﹤0.01）。术后6个月,两组患者的踝肱指数、靶病变管腔内径均高于本组术前,靶病变管腔狭窄程度均低于本组术前,且治疗组患者的踝肱指数、靶病变管腔内径均高于对照组患者,靶病变管腔狭窄程度低于对照组患者,差异均有统计学意义（P﹤0.05）。结论 药物涂层球囊治疗下肢动脉支架内再狭窄安全、有效,值得在临床上推广应用。     

肾动脉狭窄支架植入后狭窄复发的自体肾移植治疗(附6例报告)

目的：探讨肾动脉狭窄(RAS)经皮支架植入术后狭窄复发的治疗措施。方法：对6例肾动脉内支架植入后再狭窄患者行自体肾移植术治疗。结果：随访8～88个月(平均29个月)，6例自体肾移植后，2例血压转为正常，4例得到改善。3例肾功能不全中，1例改善，2例稳定。结论：自体肾移植术对肾动脉内支架植入后狭窄复发是一种安全、有效的治疗方法，能明显降低血压和改善肾功能，可列为首选。     

腔内治疗移植肾动脉狭窄一例报告

我院 2 0 0 1年 2月收治移植肾动脉狭窄 1例 ,行球囊血管成形加Ｓｔｒｅｃｋｅｒ网状支架置入术 ,效果良好 ,报告如下。患者 ,男 ,5 1岁。多囊肾慢性肾功能衰竭 ,3个月前行同种异体肾移植术。术前血压 16 0 / 10 0ｍｍＨｇ(1ｍｍＨｇ =0 .133ｋＰａ)。术后 30ｄ出现头痛 ,头晕     

血管介入治疗移植肾动脉狭窄的疗效分析

目的探讨血管介入治疗对移植肾动脉狭窄(transplanted renal arterial stenosis,TRAS)的疗效。方法回顾性分析本中心513例肾移植患者中并发TRAS的患者资料,比较血管介入治疗前、后的1周、1个月、3个月、6个月,患者的肌酐、血压及移植肾血流动力学指标的变化。结果513例肾移植患者中有9例并发TRAS,发生率为1.75%,9例患者均行血管介入治疗,其中8例患者单纯行球囊扩张术,1例患者行球囊扩张后置入血管支架。8例球囊扩张术的患者有3例术后2个月内再次出现狭窄,二次狭窄率为33.3%,再次给予球囊扩张均成功。所有患者随访6个月,1例患者血管介入治疗后4个月因肺部感染死亡。治疗前患者血肌酐为(142.3±59.6)μmol/L,治疗后1周、1个月、3个月、6个月分别为(133.5±57.2)μmol/L、(131.8±35.6)μmol/L、(127.0±29.9)μmol/L、(125.7±37.1)μmol/L,与术前相比,无统计学差异,但有下降趋势。治疗前患者收缩压为(149.7±19.3)mmHg(1 mmHg=0.133 kPa),治疗后1周、1个月、3个月、6个月分别为(131.3±4.1)mmHg、(136.2±7.9)mmHg、(128.5±6.6)mmHg、(127.1±3.6)mmHg,与术前相比,收缩压明显降低,具有统计学差异。治疗前患者移植肾主动脉峰值流速(peak systolic velocity,PSV)为(297.2±105.3)cm/s,治疗后1周、1个月、3个月、6个月分别(171±56.3)cm/s、(185.8±64.8)cm/s、(197.5±69.1)cm/s、(178.8±75.4)cm/s,与术前相比,均具有统计学差异。治疗后1周、1个月、3个月、6个月的叶间PSV、叶间动脉阻力指数,与术前相比,无统计学差异。结论血管介入治疗的疗效确切,能有效改善TRAS患者移植肾功能。     

药物洗脱支架和球囊扩张治疗自体动静脉内瘘狭窄的效果比较

目的 比较药物洗脱支架和球囊扩张治疗自体动静脉内瘘狭窄的效果和安全性。方法 回顾性分析2018年1月至2022年12月在我院手术治疗的87例自体动静脉内瘘狭窄患者的临床资料,根据手术方式分为球囊扩张组44例和支架植入组43例,比较两组患者手术成功率及术后狭窄内径、透析血流量和术后6个月、12个月初级通畅率以及术后1个月内并发症发生率。结果 所有患者临床成功率100%。支架植入组和球囊扩张组技术成功率分别为100%和91.0%。2组患者术后狭窄内径及透析血流量差异无统计学意义。支架植入组和球囊扩张组术后6个月初级通畅率分别为79.1%和45.5%,支架植入组6个月初级通畅率优于球囊扩张组,差异有统计学意义（P=0.001）。支架植入组和球囊扩张组12个月初级通畅率分别为30.2%和9.1%,支架植入组12个月初级通畅率优于球囊扩张组,差异有统计学意义（P=0.013）。两组患者术后1个月内并发症发生率差异无统计学意义。结论 药物洗脱支架治疗自体动静脉内瘘狭窄安全、有效,与球囊扩张术相比,可以提高术后初级通畅率,为治疗动静脉内瘘狭窄提供一种新的选择。     

移植肾动脉狭窄的诊治(附3例报告)

目的探讨移植肾动脉狭窄的诊治方法. 方法回顾性分析253例肾移植术后发生的3例移植肾动脉狭窄(transplant renal artery stenosis, TRAS)的诊治经过. 结果 3例TRAS均发生于肾移植术后半年内,经彩超和肾动脉造影确诊.3例均行经皮穿刺移植肾动脉球囊扩张成形(percutaneous transluminal renal angioplasty, PTRA)和血管内支架置入,获临床治愈.随访15～24个月,无TRAS复发,移植肾功能正常. 结论彩超是筛选TRAS的首选检查方法,肾动脉造影是TRAS的确诊手段.PTRA/血管内支架置入是治疗TRAS的安全、有效和首选方法.     

Minimally invasive salvage therapy for transplanted renal allografts

Abstract

Purpose: To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. Materials and methods: Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. Results: All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n?=?4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n?=?1), stenting for renal vein kinking (n?=?2), and percutaneous nephrostomy (PCN) for UO (n?=?7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0?±?3.6 to 2.6?±?2.1?mg/dL (p?<?0.001), as well as patients’ clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p?<?0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. Conclusion: Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.     

移植肾动脉狭窄腔内治疗的中期结果

目的探讨移植肾动脉狭窄经皮血管腔内成形(PTA)及支架置入的安全性及中远期结果。方法回顾性分析2011年1月至2018年12月解放军总医院血管外科收治的18例移植肾动脉狭窄患者的临床资料。结果3例经同侧股动脉,15例经对侧股动脉人路治疗。4例单纯PTA治疗,8例PTA后置入支架,6例直接置入支架。共置入14枚支架,均为球扩式支架,其中2枚为药涂支架,技术成功率100%。平均造影剂用量64ml,治疗前肾动脉狭窄率为50%〜99%,腔内治疗后狭窄率降为10%〜30%。收缩压由术前的(157.2±43.0)mmHg降至术后的(129.8±8.6)mmHg;血清肌酐(SCr)水平由术前的(258.8±214.7)μmol/L降至术后的(176.3±101.1)μmol/L,尿素氮由术前的(15.7±1.6)mmol/L降至术后(10.6±1.1)mmol/L(均P<0.05)。术后中位随访42.4个月(3~93个月),治愈17例,无效1例,1例单纯球囊扩张后术后30 d出现再狭窄,予以置入支架。除1例移植肾动脉出血外无其他并发症。结论移植肾动脉狭窄是导致移植肾失功的常见血管因素,腔内治疗安全、有效。     

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty

Abstract. One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92. 1% for SR and 69% for PTA. The long-term success rate was 81. 5% for SR and 40. 8% for PTA, with a follow-up period of 56. 722. 4 months (SR group) and 3228. 1 months (PTA group). PTA morbidity reached 28%, compared to 7. 6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.     

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty

One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n=49) or surgical repair (SR; n=39). The immediate success rate was 92.1% for SR and 69% for PTA. The long-term success rate was 81.5% for SR and 40.8% for PTA, with a follow-up period of 56.7±22.4 months (SR group) and 32±28.1 months (PTA group). PTA morbidity reached 28%, compared to 7.6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.     

肾移植术后早期移植肾动脉狭窄的诊断与治疗

目的总结肾移植术后早期发生移植肾动脉狭窄(TRAS)受者诊疗经验。 方法回顾性分析2014年1月1日至2018年8月31日复旦大学附属中山医院肾移植术后并发TRAS的16例受者(TRAS组)临床资料,并选取同期16例未发生TRAS的肾移植受者作为对照组。采用配对t检验比较两组受者介入治疗前年龄、等待移植时间、血清肌酐、估算肾小球滤过率(eGFR)、收缩压/舒张压、移植肾动脉峰值流速(PSV)和段间动脉阻力指数(RI),以及TRAS组治疗后与TRAS组治疗前、对照组治疗后血清肌酐、eGFR、收缩压/舒张压、移植肾动脉PSV、段间动脉RI的差异。采用χ²检验比较两组受者性别、供肾来源、透析方式、供肾侧别、供肾动脉吻合方式及移植肾功能延迟恢复发生情况;采用Fisher确切概率法比较两组受者移植前糖尿病、高血压和急性排斥反应发生情况。P<0.05为差异有统计学意义。 结果TRAS组受者中13例行球囊扩张,2例置入球扩支架。随访至2018年8月31日,期间除1例受者因慢性排斥反应行移植肾切除术外,余15例受者移植肾功能均稳定。两组受者年龄、性别、移植前糖尿病、移植前高血压、等待移植时间、供肾来源、透析方式、供肾侧别、供肾动脉吻合方式、移植前血清肌酐、移植肾功能延迟恢复及急性排斥反应发生情况差异均无统计学意义(P均>0.05)。介入治疗前,TRAS组受者平均血清肌酐、收缩压及移植肾动脉PSV分别为(5.6±3.5)mg/dL、(144±9)mmHg(1 mmHg＝0.133 kPa,下同)和(3.4±1.6)m/s,均高于对照组[(1.9±0.8)mg/dL、(130±19)mmHg和(1.3±0.5)m/s],差异均有统计学意义(t＝3.94、2.35和4.73,P均<0.05);TRAS组受者平均eGFR和段间动脉RI分别为(18±15)mL/min和0.5±0.1,均低于对照组[(49±20)mL/min和0.6±0.1],差异均有统计学意义(t＝－4.84和－3.88,P均<0.05)。介入治疗后,TRAS组受者平均血清肌酐、收缩压、舒张压和移植肾动脉PSV分别为(3.2±1.5)mg/dL、(128±16)mmHg、(76±8)mmHg和(2.0±1.0)m/s,较治疗前均有所下降,差异均有统计学意义(t＝3.63、4.40、3.72和3.03,P均<0.05),但平均血清肌酐高于仍高于对照组[(1.5±0.5)mg/dL],差异有统计学意义(t＝3.93,P<0.05)。TRAS组受者平均eGFR和段间动脉RI分别为(26±13)mL/min和0.6±0.1,均高于治疗前,差异均有统计学意义(t＝－4.65和－3.25,P均<0.05);但平均eGFR仍低于对照组[(58±17)mL/min],差异有统计学意义(t＝－5.75,P<0.05)。 结论对于肾移植术后怀疑发生TRAS的受者应先进行彩色多普勒血流显像检查,然后再根据血管动脉造影进行确诊。介入治疗可有效改善TRAS受者移植肾功能。     

Interventional therapy of vascular complications following renal transplantation

Abstract:  Renal transplantation is accepted as the preferred treatment for most cases of end-stage renal disease. Postoperative vascular complications include stenosis or thrombosis of the transplant renal artery or arteriovenous fistulas after biopsy. Impaired arterial perfusion of the transplant may be the leading cause for graft dysfunction or refractory hypertension. Therefore, non-invasive imaging modalities are required to detect and locate vascular complications with high accuracy. Doppler ultrasound is suited as a screening method for the detection of impaired graft perfusion. Magnetic resonance imaging (MRI) is used for an accurate diagnosis of vascular complications and to support decision for appropriate surgical or interventional treatment. Minimal invasive techniques like percutaneous transluminal angioplasty and stent placement have evolved as safe procedures with a high technical success rate reducing substantial morbidity. They can be considered as an alternative to surgical treatment of transplant renal artery stenosis (TRAS). Embolization of severe arteriovenous fistulas is the method of choice if the feeding artery can be occluded through a microcatheter. In selected cases, even catheter-guided fibrinolytic treatment of arterial thrombosis might be considered, if instantaneous surgery is considered a high-risk procedure. This article reviews the imaging features of common vascular complications after renal transplantation with focus on MRI. In addition, interventional radiological techniques are described for the treatment of TRAS, acute thrombotic occlusion, and arteriovenous fistulas.     

Stenting of transplant renal artery stenosis: outcome in a single center study

AIM: Transplant renal artery stenosis (TRAS) is the most frequent vascular complication following transplantation and is a potential curable cause of resistant hypertension, allograft dysfunction, and graft loss. Percutaneous angioplasty (PTA) is the treatment of choice, but the incidence of restenosis may be as high as 35%. Alternative treatment option combines the angioplastic procedure with the placement of a stent. The aim of this study was to evaluate retrospectively the clinical outcome of 30 patients with TRAS or post-PTA recurrent TRAS between 1991 and 2006 treated by endoluminal stenting. Primary outcomes of this study were survival rate, percentage of restenosis and lost of the graft. Secondary outcomes were: reduction of blood pressure, creatinine levels and number of antihypertensive medications. METHODS: From May 1991 to May 2006 a retrospective review of stent placement procedures for TRAS was performed. Reviewed parameters included: technical success, arterial blood pressure and number of antihypertension medications, serum creatinine level before and after intervention. Thirty-two interventions in 30 allografts were carried out. Allograft survival rate was estimated using the Kaplan-Meier METHODS: RESULTS: The technical success rate of stenting was 100% with a single major complication event (a puncture site pseudoaneurysm). Mean follow-up time was 7.1 years; of the 30 allograft that underwent stent placement, all were patent at the last follow-up, with five restenosis (15.6%) of which only one needed to be retreated endoluminally. A reduction of the mean serum creatinine levels and of the number of blood pressure medications was observed. There was no difference in the survival curve of the grafts without TRAS compared to those with stenting treated TRAS. CONCLUSION: The treatment of the TRAS with selective or primary stenting is safe with a long-term patency rate. The efficacy of the stenting in this retrospective study is suggested by a decrease in mean systolic and diastolic blood pressure, serum creatinine levels and number of blood pressure medications.     

Transplant Renal Artery Stenosis: A Case Report of Functional Recovery Six Months After Angioplasty

Transplant renal artery stenosis (TRAS) is a common vascular complication after kidney transplantation, leading to worsening or refractory hypertension, deterioration in renal function, and possible cause of graft loss. Early diagnosis and an appropriate treatment are crucial for organ preservation. Endovascular treatment, including percutaneous transluminal angioplasty and stent implantation, is considered the first-line therapy for TRAS. Here we report the case of a 69-year-old woman with end-stage renal disease for chronic kidney disease not biopsy proven, who underwent a kidney transplant from expanded criteria donors on December 2018. Postoperative course was characterized by delayed graft function. Doppler ultrasonography (US) showed an increase of peak systolic velocity at the origin of the renal artery, and parvus-tardus waveform in periferic graft arteries and an abdominal computed tomography scan confirmed a stenosis at the origin of the main renal artery (TRAS). The patient underwent a percutaneous transluminal angioplasty. It was not possible to place a stent at the particular location of the stenosis at the anastomosis. Despite the improvement of the graft's perfusion, monitored with Doppler US, the patient showed a very poor improvement in renal function and remained on hemodialysis for months. A percutaneous needle biopsy reported a normal renal parenchyma and excluded acute rejection. During this period, the patient received immunosuppressive therapy. About 6 months after the transplant, the patient had an unexpected and slow renal function recovery until she was weaned completely from hemodialysis.