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

Barbara Vajdič Trampuž,Miha Arnol,Jadranka Buturović Ponikvar,Rafael Ponikvar,Jakob Gubenšek

doi:10.1186/s12882-021-02550-4

Barbara Vajdič Trampuž, Miha Arnol + Show 3 more

Open Access

https://doi.org/10.1186/s12882-021-02550-4

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Abstract

ObjectiveTo 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 methodsWe 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.ResultsWe 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.ConclusionsAVFs 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.

Highlights

An arteriovenous fistula (AVF) is the best vascular access for hemodialysis patients [1, 2]
The Kaplan-Meier estimated kidney graft survival of our cohort is shown in Fig. 1; 1-year estimated kidney graft survival was 97%, 5-year 92% and 10-year 82%
The main cause of AVF failure was spontaneous thrombosis occurring in 76% of AVF failure cases, whereas 24% of AVFs were ligated or extirpated

Summary

Introduction

An arteriovenous fistula (AVF) is the best vascular access for hemodialysis patients [1, 2]. It remains unused, but functional in many patients. The presence of patent, but unused AVF is sometimes overlooked and questions about long-term patency and the incidence of AVF complications or systemic fistula effects remain unanswered. Can a functional AVF be of any practical value even after successful transplantation? Some transplanted patients have a poor quality of peripheral veins or vascular access problems at the time of transplantation or thereafter. We are relieved when such a patient has a patent AVF that can be used for administration of intravenous therapy, dialysis, or therapeutic plasma exchange, especially in urgent cases

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