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The Fate of Hemodialysis Vascular Access After Kidney Transplantation: Why Ligation Should Not Be Systematically Performed?

  • Ottavia Borghese
    Correspondence
    Correspondence to: Ottavia Borghese, MD, Sapienza University, Viale del Policlinico 00100, Rome, Italy
    Affiliations
    PhD in Angio-cardio-thoracic Pathophysiology and Imaging, Sapienza University, Rome, Italy

    Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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  • Angelo Pisani
    Affiliations
    PhD in Angio-cardio-thoracic Pathophysiology and Imaging, Sapienza University, Rome, Italy

    Department of Cardiovascular Surgery, Azienda Ospedaliera Santa Maria della Misericordia Perugia, Perugia, Italy
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  • Mokhles Lajmi
    Affiliations
    University of Tunis “El Manar”, Faculty of Medicine, Tunis, Tunisia

    Department of Cardiovascular Surgery, Hopital Militaire Principal d’Instruction de Tunis, Tunis, Tunisia
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  • Isabelle Di Centa
    Affiliations
    Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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Published:April 20, 2022DOI:https://doi.org/10.1016/j.avsg.2022.04.012

      Background

      After renal transplant, the haemodialysis (HD) vascular access (VA) is often maintained in the event of graft failure but evidence to recommend the systematic ligation/maintenance are lacking. We investigate the effects of VA preservation/ligation in successfully transplanted patients.

      Methods

      A retrospective analysis of all patients undergoing successful renal transplantation after HD were conducted. Patients with a functioning VA, those undergoing ligation or presenting with post-transplantation spontaneous thrombosis were included. Demographics, comorbidities, reasons for ligation, need for secondary interventions, complications and return in dialysis were assessed.

      Results

      Out of 542 HD patients, 114 (76, 66.7% male, median age 50 years, range 20–70) were included. Eight (7%) accesses thrombosed in a mean of 1.4 days (range 1–3) after transplant; 42 (36.8%) fistulas were ligated and 64 (56.1%) preserved. The reasons for ligation were patient’s request (35, 83.3%), steal syndrome (5, 11.9%), heart failure (1, 2.4%) and aneurysmal degeneration (1, 2.4%).During a mean follow-up of 724.9 days (range 80–1082) 25 patients developed complications over the maintained access (40% of stenosis; 32% high flow and 28% thrombosis); 18 (15.8%) needed reoperation; 17 (15%) required further HD. Multivariate analysis showed that coronary artery disease (OR= 12.566 [2.056–76.805], P < 0.06) or age >60 years (OR=0.181 [0.044–0.735], P = 0.017) were risk factor for complications over unused VA.

      Conclusions

      The ligation of a functioning VA after renal transplant should evaluated on an individualized basis. Patients with pre-existing cardiovascular disease or aged >60 years should be monitored closely up as they are at higher risk of complications.
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