通过对中重度移植肾动脉狭窄(TRAS)患者的临床特征、治疗预后进行系统性评估，探索肾移植术后发生中重度TRAS的危险因素，为早期预防、诊断和治疗提供依据。

回顾性分析2022年1月至2024年7月在北部战区总医院进行肾移植，并在随访中确诊为中重度TRAS的16例患者临床资料，以接受同一供者另一侧供肾的受者作为对照。收集患者基本情况、临床表现、实验室检查结果、治疗方式以及预后情况。计量资料采用独立样本t检验、Mann-Whitney U检验或配对样本t检验比较，计数资料采用卡方检验或Fisher确切概率法进行比较。采用Cox比例风险回归分析中重度TRAS危险因素。绘制受试者操作特征曲线(ROC曲线)评估危险因素对TRAS的预测效能。

肾移植术后中重度TRAS发生率为4.5%，发生中位时间为术后157 d。发生TRAS时，TRAS组中性粒细胞比值、血清尿素氮、肌酐和胱抑素水平均高于对照组，血红蛋白低于对照组(P均<0.05)。单因素分析显示，与对照组比较，TRAS组患者体质指数较低，二次移植比例较高，使用咪唑立宾患者较多，血清脂蛋白a水平较高，差异均有统计学意义(P均<0.05)。将以上因素纳入Cox比例风险回归分析，结果显示二次移植(HR＝5.772，95%CI：1.227~26.684，P<0.05)、高水平脂蛋白a(HR＝1.008，95%CI：1.002~1.013，P<0.05)是发生中重度TRAS的独立危险因素。对脂蛋白a绘制ROC曲线分析显示，曲线下面积0.771(95%CI：0.597~0.946，P<0.05)，最佳截断值为74.95 nmol/L。TRAS组患者9例支架植入，2例单纯球囊扩张，5例球囊扩张联合支架植入；术后3、7、14和28 d以及术后2个月和3个月血清肌酐与术前比较，差异均有统计学意义(t＝2.959、3.354、2.795、3.148、3.040和3.721，P<0.05)。

肾移植受者发生中重度TRAS时患者中性粒细胞比值较高，贫血更为严重，血清尿素氮、肌酐和胱抑素水平均明显升高。对于二次移植及脂蛋白a高于74.95 nmol/L的患者，中重度TRAS发生风险较高。介入治疗可显著改善中重度TRAS患者肾功能。

To systematically evaluate the clinical characteristics and treatment prognosis of patients with moderate-to-severe transplant renal artery stenosis (TRAS), and to explore the risk factors of TRAS after kidney transplantation, providing the basis for early prevention, diagnosis, and treatment.

The clinical data of 16 patients who underwent kidney transplantation in Northern Theater Command General Hospital from January 2022 to July 2024 and were diagnosed with moderate-to-severe TRAS during follow-up were retrospectively analyzed, and recipients who received the other kidney from the same donor were selected as the control group. The basic information, clinical manifestations, laboratory test results, treatment methods, and prognosis of the patients were collected. Independent sample t-test, Mann-Whitney U test, or paired sample t-test were used for comparative analysis of measurement data, while chi-square test or Fisher′s exact probability method were applied to count data. Cox proportional hazards regression was used to analyze risk factors for moderate-to-severe TRAS. The receiver operating characteristic curve (ROC) was used to evaluate the predictive performance of risk factors for TRAS.

The incidence of moderate-to-severe TRAS after kidney transplantation was 4.5%, with a median time of 157 days post-transplantation. At the time of TRAS diagnosis, the TRAS group had significantly higher neutrophil ratio, serum urea nitrogen, creatinine, and cystatin levels, and lower hemoglobin levels compared to the control group (all P<0.05). Univariate analysis showed that the TRAS group had a lower body mass index, higher proportion of re-transplantation, more frequent use of mizoribine, and higher serum lipoprotein a levels compared to the control group, with statistically significant differences (all P<0.05). Cox proportional hazards regression analysis showed that re-transplantation (HR=5.772, 95%CI: 1.227-26.684, P<0.05) and high lipoprotein a levels (HR=1.008, 95%CI: 1.002-1.013, P<0.05) were independent risk factors for moderate-to-severe TRAS. ROC curve analysis for lipoprotein a showed that the area under the curve was 0.771 (95%CI: 0.597-0.946, P<0.05), and the optimal cutoff value was 74.95 nmol/L. In the TRAS group, 9 patients were stented, 2 patients were treated with balloon dilatation alone, and 5 patients were treated with balloon dilatation combined with stent implantation; serum creatinine at 3, 7, 14, 28 days and 2, 3 months after interventional therapy was significantly different from that before surgery (t=2.959, 3.354, 2.795, 3.148, 3.040, and 3.721, P<0.05).

Patients with moderate-to-severe TRAS after kidney transplantation exhibit higher neutrophil ratios, more severe anemia, and significantly elevated serum urea nitrogen, creatinine, and cystatin levels. Interventional therapy can significantly improve renal function in such patients. Patients with re-transplantation and lipoprotein a levels >74.95 nmol/L were at higher risk of moderate-to-severe TRAS.