Outcome of Arteriovenous Fistula Following Renal Transplantation AVF Outcomes Post-Renal Transplantation
Main Article Content
Abstract
Background: Renal transplantation is the preferred treatment for end-stage renal disease (ESRD), but the management of arteriovenous fistulas (AVFs) post-transplant remains controversial due to complications like thrombosis.
Objective: To determine the outcome of AVFs following renal transplantation, focusing on the incidence and timing of AVF thrombosis.
Methods: This ambi-directional cohort study included 155 patients with ESRD who underwent kidney transplantation at the Sindh Institute of Urology and Transplantation, Karachi, in 2021. All included patients had a functional AVF at the time of transplantation. Data were collected from electronic health records, including demographic information, AVF characteristics, and incidence of thrombosis. AVF outcomes were monitored through follow-up assessments until September 2024. Statistical analysis was conducted using SPSS version 25, with significance set at p<0.05.
Results: Thrombosis occurred in 71 (45.8%) patients, most frequently within one week (14.8%), within four weeks (21.9%), and within one year (34.2%). Surgical ligation was required in 5 patients (3.22%). No significant associations were found between thrombosis and age, comorbidities, or AVF type (p>0.05).
Conclusion: AVF thrombosis is a frequent complication post-transplant, not significantly influenced by patient demographics or AVF type, highlighting the need for continued surveillance.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Vernooij RW, Law W, Peters SA, Canaud B, Davenport A, Grooteman MP, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ. The Probability of Receiving a Kidney Transplantation in End-Stage Kidney Disease Patients Who Are Treated with Haemodiafiltration or Haemodialysis: A Pooled Individual Participant Data from Four Randomised Controlled Trials. BMC Nephrology. 2021;22:1-9.
Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, Hays R, Howard A, Jones E, Leichtman AB, Merion RM. Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) Conference. Clin J Am Soc Nephrol. 2008;3(2):471-80.
Suthanthiran M, Strom TB. Renal Transplantation. N Engl J Med. 1994;331(6):365-76.
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant. N Engl J Med. 1999;341(23):1725-30.
Navuluri R, Regalado S. The KDOQI 2006 Vascular Access Update and Fistula First Program Synopsis. Semin Intervent Radiol. 2009;26(2):122-4.
Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF. Hemodialysis Clinical Practice Guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol. 2006;17(3 Suppl 1).
Unger P, Wissing KM. Arteriovenous Fistula After Renal Transplantation: Utility, Futility or Threat?. Nephrol Dial Transplant. 2006;21(2):254-7.
Voorzaat BM, Janmaat CJ, Wilschut ED, Van Der Bogt KE, Dekker FW, Rotmans JI. No Consensus on Physicians’ Preferences on Vascular Access Management After Kidney Transplantation: Results of a Multi-National Survey. J Vasc Access. 2019;20(1):52-9.
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4).
Kumwenda M, Mitra S, Reid C. Clinical Practice Guideline: Vascular Access for Haemodialysis - UK Renal Association.
Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J. EBPG on Vascular Access. Nephrol Dial Transplant. 2007;22(suppl_2).
Vajdič B, Arnol M, Ponikvar R, Kandus A, Buturović-Ponikvar J. Functional Status of Hemodialysis Arteriovenous Fistula in Kidney Transplant Recipients as a Predictor of Allograft Function and Survival. Transplant Proc. 2010;42(10):4006-9.
Laham G, Pujol GS, Vilches A, Cusumano A, Diaz C. Nonprogrammed Vascular Access is Associated with Greater Mortality in Patients Who Return to Hemodialysis with a Failing Renal Graft. Transplantation. 2017;101(10):2606-11.
Patard JJ, Bensalah K, Lucas A, Rodriguez A, Manunta A, Rivalan J, Pogamp PL, Lobel B, Guillé F. Management of Vascular Access for Hemodialysis After Successful Kidney Transplantation. Scand J Urol Nephrol. 2002;36(5):373-6.
Vajdič Trampuž B, Ponikvar R, Kandus A, Buturović-Ponikvar J. Hemodialysis Arteriovenous Fistula-Related Complications and Surgery in Kidney Graft Recipients. Ther Apher Dial. 2013;17(4):444-7.
Yaffe HC, Greenstein SM. Should Functioning AV Fistulas Be Ligated After Renal Transplantation?. J Vasc Access. 2012;13(4):405-8.
Fishman JA. Infection in Solid-Organ Transplant Recipients. N Engl J Med. 2007;357(25):2601-14.
Karim MS, Aryal P, Gardezi A, Clark DF, Aziz F, Parajuli S. Vascular Access in Kidney Transplant Recipients. Transplant Rev. 2020;34(3):100544.
Bardowska K, Letachowicz K, Kamińska D, Kusztal M, Gołębiowski T, Królicki T, Zajdel K, Mazanowska O, Janczak D, Krajewska M. The Attitude of Kidney Transplant Recipients Towards Elective Arteriovenous Fistula Ligation. PLoS One. 2020;15(7).
Ahmed J, Azhar S, ul Haq N, Hussain S, Stájer A, Urbán E, Gajdács M, Jamshed S. Awareness of Chronic Kidney Disease, Medication, and Laboratory Investigation Among Nephrology and Urology Patients of Quetta, Pakistan. Int J Environ Res Public Health. 2022;19(9):5015.