P1327STATUS OF AV FISTULA AFTER SUCCESSFUL RENAL TRANSPLANT ; A SINGLE CENTRE STUDY

Abstract

Abstract Background and Aims Functioning AV-Fistula is considered the Achilles hill of ESRD patients. After successful renal transplantation considering the risk of graft failure or recurrence of disease all attempts are made to preserve the functional AV fistula except few clinical situations like high output cardiac failure, steal phenomenon or large aneurysm with risk of rupture where voluntary closure of AVF is preferred. Even with care and attention a significant number of AV-Fistula closes spontaneously. In this retrospective study we analyzed the fate of AVF after successful renal transplantation. Method The medical records 800 renal transplant recipients in last 15 years were analyzed with the objective to find out the outcome of AVF after transplant. Data were systematically charted and analyzed by SPSS V.23.01 Results Out of 800 renal transplantation in last 15 years, excluding patients on CAPD or temporary catheter or AVgraft; 680 patients data were finally analyzed. Out of this 680 functioning AVF, 86 patients lost follow up and hence status of AVF could not be retrieved. Among rest 594 recipients, AV fistula was closed spontaneously in 184 cases (31.1%), and only 5 patients required planned AVF closure due to large aneurysm (2 cases), trauma and impending rupture (2 cases), cosmetic reason (1 cases). Incidence of spontaneous fistula closure was significantly higher among females than male recipients (p=0.001). Majority (62%) of the spontaneous closure occurred immediate post transplant period (within 7 days after transplant) and rest 26.4% within 1month and 9.2% in between 1 and 4 month. Only 2.4% fistula closed after 4 month of transplant. In the Tacrolimus era there is no significant difference in the rate of spontaneous closure with the patients who received cyclosporine (p=0.78). However among patient who received injectable cyclosporine the spontaneous closure was significantly higher (p=0.001). Factors which could be attributable to the rate of closure are, need of peripheral cannulation in perioperative period in the fistula arm (r2=0.89), operative time more than 2and half hr (r2=0.78), more than 2 unit of blood transfusion (r2=0.85) during operation and dialysis vintage through AVF less than 6 month (r2=0.77). There was no observed difference in rate of spontaneous closure among patients who received induction and who don’t (p=0.08). In subgroup analysis among induction with basiliximab or thymoglobulin there was no significant difference in spontaneous fistula closure (p=0.07). Conclusion Spontaneous closure of AV fistula observed in 31.1% patients with successful renal transplantation. It is more common in female recipients and 97.6% of spontaneous closure takes place within 4month of transplant. The factors which are attributable for spontaneous closure are cannulation in the fistula arm, injectable cyclosporine use, operative time more than 2and half hr, blood transfusion more than 2 units, during operation.