Prophylactic Ligature of AV Fistula Prevents High Output Heart Failure after Kidney Transplantation

Hetz, Patrick; Pirklbauer, Markus; Müller, Silvana; Posch, Lydia; Gummerer, Maria; Tiefenthaler, Martin

doi:10.1159/000508957

Cited by 20 publications

(16 citation statements)

References 28 publications

(36 reference statements)

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“…The mean AVF Qb in the intervention group was 2197.2 mL/min when compared to the mean of 850.9 mL/min in the non-intervention group. A recent randomized controlled study by Hetz et al 33 showed that prophylactic ligation of high flow AVFs with Qb > 1.5 L/min prevented high-output cardiac failure. Although the total number of patients in the study was small ( n = 28) the results showed that 38.5% of patients developed high-output heart failure in the control group whereas no patients in the AVF ligation group developed heart failure ( p = 0.013).…”

Section: Maintaining Avf After Kidney Transplant: Harmsmentioning

confidence: 99%

To ligate or not to ligate hemodialysis arteriovenous fistulas in kidney transplant patients

2020

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There is significant disagreement about maintenance or ligation of arteriovenous fistulas (AVFs) in kidney transplant patients (KTPs). Potential harms from maintaining AVFs are their impact on cardiac function, cosmetic concerns and complications such as bleeding and rupture. High flow AVFs can place a strain on the heart and cause or exacerbate pre-existing cardiac dysfunction. There is an improvement in cardiac function after kidney transplantation independent of vascular access status. Studies comparing cardiac parameters in patients with and without AVFs after renal transplantation have shown conflicting results. Ligation of high flow AVFs in KTPs resulted in improvement in cardiac function and prevention of heart failure. In KTPs with deteriorating renal function and high flow AVFs, banding of the AVFs to reduce flow is an option. Patients who retain AVFs after renal transplant have the advantage of immediate, optimal access should the transplant fail and may have preserved kidney function. The patient’s post-transplant kidney function, risk factors for transplant loss, AVF blood flow, and cardiac function play an important role when making the decision to ligate or preserve AVFs.

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Section: Maintaining Avf After Kidney Transplant: Harmsmentioning

confidence: 99%

To ligate or not to ligate hemodialysis arteriovenous fistulas in kidney transplant patients

2020

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“…While recent years have seen an increase in the amount of available data on deleterious effects of functioning AVF [44,45], the majority of studies included symptomatic patients with high-flow AVFs. Our study mainly included patients with mild or no symptoms and with distal vascular access, unlike studies assessing the trajectory of eGFR after fistula formation and closure.…”

Section: Discussionmentioning

confidence: 99%

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

Letachowicz

Królicka

Tukiendorf

et al. 2022

JCM

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Lung ultrasound is a bedside technique for the assessment of pulmonary congestion. The study aims to assess the severity of lung congestion in kidney transplant recipients (KTR) in relation to arteriovenous fistula (AVF) patency. One hundred fifty-seven patients at least 12 months after kidney transplantation were recruited to participate in a cross-sectional study. Apart from routine visits, lung ultrasound at 28 typical points was performed. The patients were assigned to either AVF+ or AVF− groups. The mean number of lung ultrasound B-lines (USBLs) was 5.14 ± 4.96 with no differences between groups: 5.5 ± 5.0 in AVF+ and 4.8 ± 4.9 in AVF−, p = 0.35. The number and proportion of patients with no congestion (0–5 USBLs), mild congestion (6–15 USBLs), and moderate congestion (16–30 USBLs) were as follows: 101 (64.7%), 49 (31.4%), and 6 (3.8%), respectively. In multivariate analysis, only symptoms (OR 5.90; CI 2.43,14.3; p = 0.0001), body mass index (BMI) (OR 1.09; CI 1.03,1.17; p = 0.0046), and serum cholesterol level (OR 0.994; CI 0.998,1.000; p = 0.0452) contributed significantly to the severity of lung congestion. Lung ultrasound is a valuable tool for the evaluation of KTR. Functioning AVF in KTR is not the major factor affecting the severity of pulmonary congestion.

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“…However, it should be noted that in our study cohort, Qa and prevalence of upper arm AVFs were lower. In a recent study of Hetz et al conducted in KTx patients with a Qa>1,500 ml/min., the prevention of right sided heart failure was noticed after VA ligature ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Vascular Access Perspectives in Patients After Kidney Transplantation

et al. 2021

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Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

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Prophylactic Ligature of AV Fistula Prevents High Output Heart Failure after Kidney Transplantation

Cited by 20 publications

References 28 publications

To ligate or not to ligate hemodialysis arteriovenous fistulas in kidney transplant patients

To ligate or not to ligate hemodialysis arteriovenous fistulas in kidney transplant patients

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

Vascular Access Perspectives in Patients After Kidney Transplantation

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