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Introduction <p>Takayasu arteritis (TA) is a large-vessel vasculitis that often involves the aorta and its major branches. Renovascular hypertension is a common complication of TA. While medical therapy and endovascular interventions are the mainstay of management, certain anatomically complex cases may not be amenable to standard treatment. We present a case of Takayasu arteritis with treatment-resistant hypertension successfully managed with autologous renal transplantation.</p> Case Presentation <p>A 29-year-old Sri Lankan female presented with uncontrolled hypertension and constitutional symptoms. Imaging revealed Takayasu arteritis type III–IV with 90% stenosis of the left renal artery and 25% stenosis of the right renal artery. Despite treatment with glucocorticoids, azathioprine, tocilizumab, and five antihypertensive agents, blood pressure remained more than 180/90&#xa0;mmHg. An attempted endovascular procedure failed, and surgical revascularisation was deemed unfeasible due to long-segment arterial involvement. The patient underwent autologous renal transplantation, where the left kidney was explanted and re-implanted into the right iliac fossa using a venous graft. Histology of the excised artery showed fibrotic thickening and mucoid degeneration without active inflammation. Post-operatively, blood pressure was well controlled with three antihypertensive agents, and there was no evidence of graft dysfunction or restenosis at 1&#xa0;year.</p> Conclusion <p>Autologous renal transplantation is a viable therapeutic option for selected patients with Takayasu arteritis and complex renovascular hypertension when conventional revascularisation is not feasible. This case highlights the importance of multidisciplinary management and surgical innovation in vasculitis care.</p>

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Autologous Renal Transplant for Critical Renal Artery Stenosis in Takayasu Arteritis: a Case Report and a Literature Review

  • 期刊论文

  • 发表日期：

    2025年7月14日

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  • Pramith Ruwanpathirana,
  • Thamalee Palliyaguru,
  • Supun Godahewa,
  • Selvantharajah Shiyanth,
  • Nalaka Gunawansa,
  • Inoshi Atukorala

摘要

Introduction

Takayasu arteritis (TA) is a large-vessel vasculitis that often involves the aorta and its major branches. Renovascular hypertension is a common complication of TA. While medical therapy and endovascular interventions are the mainstay of management, certain anatomically complex cases may not be amenable to standard treatment. We present a case of Takayasu arteritis with treatment-resistant hypertension successfully managed with autologous renal transplantation.

Case Presentation

A 29-year-old Sri Lankan female presented with uncontrolled hypertension and constitutional symptoms. Imaging revealed Takayasu arteritis type III–IV with 90% stenosis of the left renal artery and 25% stenosis of the right renal artery. Despite treatment with glucocorticoids, azathioprine, tocilizumab, and five antihypertensive agents, blood pressure remained more than 180/90 mmHg. An attempted endovascular procedure failed, and surgical revascularisation was deemed unfeasible due to long-segment arterial involvement. The patient underwent autologous renal transplantation, where the left kidney was explanted and re-implanted into the right iliac fossa using a venous graft. Histology of the excised artery showed fibrotic thickening and mucoid degeneration without active inflammation. Post-operatively, blood pressure was well controlled with three antihypertensive agents, and there was no evidence of graft dysfunction or restenosis at 1 year.

Conclusion

Autologous renal transplantation is a viable therapeutic option for selected patients with Takayasu arteritis and complex renovascular hypertension when conventional revascularisation is not feasible. This case highlights the importance of multidisciplinary management and surgical innovation in vasculitis care.