Risk Factors of Transplant Renal Artery Stenosis: A Meta-analysis

Background: Transplant renal artery stenosis (TRAS) is a typical vascular complication that accounts for 75 of all vascular events following kidney transplantation. Post-transplant complications such as allograft dysfunction, allograft loss, and post-transplant hypertension have been attributed to TRAS. This study aims to evaluate the risk factors related to TRAS after kidney transplantation. Methods: A meta-analysis of studies that were published from inception until January 2024 was accomplished from the Science Direct and PubMed databases. Publications evaluating the prevalence of TRAS after kidney transplantation and assessing its risk factors were included in the study. Results: Sixteen publications were included in the study. The incidence of TRAS was 1465 cases (3.37) from 43,446 patients. Several variables relating to the occurrence of TRAS after kidney transplantation were examined. The variables that related to the development of TRAS were multiple allograft arteries (OR 3.08 95% CI 1.30-7.28, P = .01, I² = 33%), cold ischemia times (MD 4.40 95% CI 3.72-5.08, P < .00001, I² = 0%), hypertension (RR 1.07 1.03-1.11, P = .0006, I² = 0%), diabetes (RR 1.16 1.04-1.29, P = .007, I² = 24%), ischemic heart disease (RR 1.51 1.26-1.82, P < .00001, I² = 0%), systolic blood pressure (MD 10.98 9.44-12.51, P < .00001, I² = 0%), diastolic blood pressure (MD 7.64 2.30-12.97, P = .005, I² = 85%), delayed graft function (OR 2.11 1.31-3.38, P = .002, I² = 58%), and acute rejection (RR 1.84 1.24-2.71, P = .002, I² = 0%). Conclusions: Multiple variables have been identified as risk factors for TRAS. Since TRAS is linked to allograft dysfunction and poorer outcomes, effectively managing and improving these factors could result in better long-term results for kidney transplant recipients. © 2025 Elsevier Inc.