Predictors of Autogenous Arteriovenous Hemodialysis Access Thrombosis after Renal Transplantation

Abstract

The fate of autogenous arteriovenous fistula (aAVF) after renal transplantation (RT) remains variable. The aim of this study was to determine the predictors for their thrombosis after RT. We conducted a monocentric retrospective review of prospective clinical records of 145 patients with a functional aAVF who had an RT between January 2004 and December 2009 in the University Hospital of Clermont-Ferrand. Our primary end point was the thrombosis of the aAVF. Univariate and multiple logistic regression analyses were used to identify risk factors associated to aAVF thrombosis after RT. There were 105 men (72%) and 40 women (28%), mean age 52years (range: 18.4-74.7years). The aAVF was created on average 40months (range: 2-169) before the RT. The aAVF was distal in 96 cases (66%) and proximal in 49 cases (34%). Nineteen aAVF (13.1%) were complicated and required an endovascular or surgical repair before RT. Forty-nine patients (34%) required multiple aAVF (>2). Mean follow-up from RT was 58months (range: 1day-123months) and from aAVF creation 97months (range: 5-262months). At the end of the follow-up, 81 aAVFs (59%) were patent, 42 (29%) were thrombosed, and 22 (15%) were surgically closed. Patients that had multiple fistulas before RT and active smokers were significantly at risk to thrombose their aAVF after the RT in univariate (P=0.03 and P=0.02, respectively) and multiple logistic regression analyses (P=0.03 and P=0.047, respectively). Thrombosis is a part of the natural history of the aAVF after RT. A history of multiple aAVF creations before RT and active smoking were associated to significant increased risk for fistula thrombosis. Because hemodialysis may be needed after RT, the aAVF patency should be preserved, excepted when the aAVF resulted in complications. Follow-up of the aAVF after RT is important to detect and treat complications before thrombosis occurs.