PERIPHERAL VASCULAR DISEASE
Initial experience with the use of fractional flow reserve in the
hemodynamic evaluation of transplant renal artery stenosis
Manuel Pereira Marques Gomes J
audia Maria Rodrigues Alves, MD, PhD
Adriano Henrique Pereira Barbosa, MD, PhD
Adriano Caixeta, MD, PhD
Marcelo Costa Batista, MD, PhD
e Osmar Medina Pestana, MD
onio Carlos Carvalho, MD
Interventional Cardiology Catheterization
Laboratory Unit, Cardiology Division,
Universidade Federal de S
ao Paulo, Escola
Paulista de Medicina, UNIFESP/EPM, S
Paulo, SP, Brazil
Departament of Nefrology, Universidade
Federal de S
ao Paulo, Escola Paulista de
Medicina, UNIFESP/EPM, S
ao Paulo, SP,
Cardiology Division, Universidade Federal
ao Paulo, Escola Paulista de Medicina,
ao Paulo, SP, Brazil
Manuel Pereira Marques Gomes J
Rua Alves Guimar
aes, 408-82 Pinheiros-
ao Paulo, CEP: 05410000, SP Brazil.
Objective: To describe and standardize an original protocol for fractional flow reserve (FFR) pre
and postangioplasty in an initial series of patients with clinically manifested transplant renal artery
Background: There is no data in the literature about the use of FFR in TRAS.
Methods: Patients with TRAS detected in a noninvasive study were referred to diagnostic angiog-
raphy and stenosis considered visually severe ( 60%) were included. After selective cannulation, a
PressureWire 0.014” (Certus
—St. Jude Medical) was advanced to the distal portion of the vessel.
Resting Pd/Pa ratio (ratio of mean distal to lesion and mean proximal pressures) and translesional
systolic pressure gradient were obtained and FFR and hyperemic translesional systolic and mean
pressure gradients (HSG and HMG) were registered after papaverine induced maximum hyperemia
—pre and poststent implantation. Creatinine levels and office blood pressure measurements were
registered at the baseline, 6 and 12 months after intervention.
Results: Ten consecutive patients had successful stent implantation and were included. After
treatment, significant increase in FFR (0.76 6 0.09 vs. 0.96 6 0.04, P < 0.001) and reduction in
systolic hyperemic gradients (–41.40 6 19.18, P < 0.001) and mean (–24.00 6 11.65, P < 0.001)
were observed. A strong negative correlation was observed between FFR and percent stenosis
diameter—%SD (r 5 –0.89, P < 0.001) and HSG (r 5 –0.9, P < 0.001) as well as a strong positive
correlation between FFR and baseline Pd/Pa ratio (r 5 0.9, P < 0.001).
Conclusion: FFR was a well-tolerated, valid and reproducible tool during percutaneous interven-
tion for TRAS. Good correlation was observed between FFR and others hemodynamic parameters
of lesion severity.
angioplasty, fractional flow reserve, kidney transplantation, renal artery obstruction
Transplant renal artery stenosis (TRAS) is the main vascular complica-
tion of renal transplant, responsible for at least 75% of the cases.
Although often asymptomatic and underdiagnosed, it is responsible for
1–5% of the resistant hypertension cases and the leading cause of graft
dysfunction and premature death of the receiver .
TRAS has widely varying prevalence in the literature, from 1 to
23% [2,3], due to different factors: the expansion in the use of nonin-
vasive diagnostic methods as a screening tool, the differences in
2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/ccd Catheter Cardiovasc Interv. 2018;91:820–826.
Received: 30 March 2017
Revised: 7 November 2017
Accepted: 25 November 2017