Abstract: TH-PO780
Fistula Ligation after Kidney Transplant: Yes or No?
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Ahmed, Farah M., St George's University of London, London, London, United Kingdom
- Montero, Rosa M., St George's University Hospitals NHS Foundation Trust, London, London, United Kingdom
Background
Cardiovascular disease (CVD) accounts for 30-35% of all-cause mortality in kidney transplant recipients (KTR) causing 25% of deaths 1-year post-transplant. Arteriovenous Fistulas(avf) have been shown to contribute to CVD progression with up to 42% of ESRD patients on dialysis developing Heart Failure and Pulmonary Hypertension. We report our experience with avf ligation in KTR.
Methods
A single centre retrospective observational study of all KTR with existing avf at the time of their transplant between 1983-2023 were included. Demographic and clinical outcome data was collected from electronic patient records including dates of avf formation and ligation, echocardiogram (echo) details at baseline and post-transplant. All KTR were categorised into 4 groups according to EF; group 1 <35%, group 2 36-49%, group 3 50-54%, group 4 ≥55% according to British Society of Echocardiography classification. Paired t-tests and ANOVA were used to perform statistical analysis with a p<0.05 significant level.
Results
340 KTR from 1983- 2023 had avf in our centre. 214 Male, 126 female with a median age 63yrs (25-88yrs). 122 White, 80 Black, 97 Asian, 6 Chinese, 24 Other, 11 Unknown. 142 (42%) had avf ligation of which 17 KTR previously had >1 avf ligated leaving 116 KTR with avf ligated in total (73Male, 43Female). 20% (23/116) died unrelated to the procedure. Median time avf duration 9yrs (1-41yrs), median time post-KT avf ligation 5yrs (0-21yrs). 52% (61/116) had pre-KT echo classified according to EF: Group 1 had 1 KTR, Group 2: 5, Group 3: 8 Group 4 47. 20 KTR had a subsequent echo post ligation. 55% (11/20) had pre and post echo with 6 KTR showing an improvement moving from group 3 to 4(5) and group 2 to 4(1) in this small sample (p=0.06). Creatinine significantly improved pre-post KT (p<0.001). The changes were not related to the type of avf.
Conclusion
Many KTR did not meet the criteria for echo pre- transplant work-up leading to a smaller cohort. 11 KTR had an echo after avf ligation. An insignificant trend towards improvement in EF was seen despite the small sample size. Given the lack of guidance in this area consideration should be given to performing an echo 1 year after ligation to determine whether there is any improvement in cardiac function given the high cardiovascular morbidity and mortality of KTR.