The attitude of kidney transplant recipients towards elective arteriovenous fistula ligation

Bardowska, Klaudia; Letachowicz, Krzysztof; Kamińska, Dorota; Kusztal, Mariusz; Gołębiowski, Tomasz; Królicki, Tomasz; Zajdel, Karolina; Mazanowska, Oktawia; Janczak, Dariusz; Krajewska, Magdalena

doi:10.1371/journal.pone.0234931

Cited by 6 publications

(8 citation statements)

References 32 publications

(36 reference statements)

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“…Finally, majority of the patients did not want to close the AVF. It is in line with our questionnairebased study (8). It could be a consequence of our former view that the cardiovascular effect of a functioning AVF is mild and high prevalence of distal AVFs.…”

Section: Discussionsupporting

confidence: 91%

“…The results of a recent meta-analysis demonstrated that AVF closure was related with an improved cardiac morphology, and a better kidney graft function and AVF closure had been suggested as a considerable approach in patients with a well-functioning allograft (32). Despite the modification of the cardiovascular risk through an intervention on AVF seems to be a promising intervention in KTx recipients, the patients were not convinced to a routine VA ligation (8). An alternative option could be a precision flow reduction by banding with a real-time access flow assessment or banding with the use of a sizing dowel (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the interest in VA in KTx recipients is growing. The main research topics are: cardiac impact, potential renal function preservation, transplantation-dialysis transition, patients and professionals' opinion (6)(7)(8)(9). The problems of vascular access for dialysis could not be perceived until the very late phases of renal failure (despite regular follow up) in patients with a failing renal transplant resulting in a more frequent use of a catheter (10).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vascular Access Perspectives in Patients After Kidney Transplantation

et al. 2021

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“…38.5% of patients never wanted to ligate the AVF, and 38.5% of patients had no clear opinion. Paradoxically, patients with the worst kidney graft function and a distally located AVF had the highest proportion of individuals willing to ligate their vascular access [29].…”

Section: Discussionmentioning

confidence: 99%

“…The individual risk of graft dysfunction and a return to chronic HD needs to be balanced [32]. There is also a clear need to educate patients about posttransplant AVF management options [29].…”

Section: Discussionmentioning

confidence: 99%

A national cohort study on hemodialysis arteriovenous fistulas after kidney transplantation - long-term patency, use and complications

et al. 2021

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Objective To describe the long-term hemodialysis arteriovenous fistula (AVF) patency, incidence of AVF use, incidence and nature of AVF complications and surgery in patients after kidney transplantation. Patients and methods We retrospectively analysed the AVF outcome and complications in all adult kidney allograft recipients transplanted between January 1st, 2000 and December 31, 2015 with a functional AVF at the time of transplantation. Follow-up was until December 31, 2019. Results We included 626 patients. Median AVF follow-up was 4.9 years. One month after kidney transplantation estimated AVF patency rate was 90%, at 1 year it was 82%, at 3 years it was 70% and at 5 years it was 61%; median estimated AVF patency was 7.9 years. The main cause of AVF failure was spontaneous thrombosis occurring in 76% of AVF failure cases, whereas 24% of AVFs were ligated or extirpated. In a Cox multivariate model female sex and grafts were independently associated with more frequent AVF thrombosis. AVF was used in about one third of our patients. AVF-related complications occurred in 29% of patients and included: growing aneurysms, complicated thrombosis, high-flow AVF, signs of distal hypoperfusion, venous hypertension, trauma of the AVF arm, or pain in the AVF/arm. Conclusions AVFs remain functional after kidney transplantation in the majority of patients and are often re-used after graft failure. AVF-related complications are common and require proper care.

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