Effect of systemic immunosuppressive drugs on the patency of hemodialysis accesses .

Abstract

Intimal hyperplasia remains the leading cause of late hemodialysis access stenosis or occlusion. This study assessed the influence of conventional immunosuppressive drugs on the patency of hemodialysis accesses in patients with a history of organ transplantation. Between January 2002 and December 2007, 1,654 patients underwent an operation for hemodialysis access. 135 patients received immunosuppressive therapy (IT); of these, 115 underwent an operation for hemodialysis access after transplanted graft failure and 20 patients after liver transplantation. The 5-year primary patency rates of hemodialysis access were compared twice between the entire study population and the matched cohorts using a 1:4 propensity score. A total of 82.2% of the nontransplanted (NT) patients and 71.9% of the IT patients had arteriovenous fistulas (AVFs). The 5-year primary patency rate was 74.0% for the NT group and 51.5% for the IT group (p<0.001). The characteristics of the matched cohorts (135 IT patients and 536 NT patients) were well balanced; the 5-year primary patency rates were 70.0% and 54.9% for the NT and IT groups, respectively (p=0.030). A significant impact of IT on primary patency was not observed in the matched cohort (hazard ratio, 0.930; 95% confidence interval, 0.706-0.226; p=0.608). Systemic administration of immunosuppressive drugs did not significantly affect the patency of AVF or arteriovenous graft (AVG) access in the present study. .