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Salehi T, Montarello NJ, Juneja N, Stokes MB, Scherer DJ, Williams KF, King D, Macaulay E, Russell CH, Olakkengil SA, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT, Rao NN. Long-Term Impact of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients: A 5-Year Follow-Up Observational Cohort Study. KIDNEY360 2021; 2:1141-1147. [PMID: 35368362 PMCID: PMC8786094 DOI: 10.34067/kid.0000692021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023]
Abstract
Background The long-term effects of arteriovenous fistula (AVF) ligation on cardiovascular structure following kidney transplantation remain uncertain. A prospective randomized, controlled trial (RCT) examined the effect of AVF ligation at 6 months on cardiovascular magnetic resonance imaging (CMR)-derived parameters in 27 kidney transplant recipients compared with 27 controls. A mean decrease in left ventricular mass (LVM) of 22.1 g (95% CI, 15.0 to 29.1) was observed compared with an increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). We conducted a long-term follow-up observational cohort study in the treated cohort to determine the evolution of CMR-derived parameters compared with those documented at 6 months post-AVF ligation. Methods We performed CMR at long-term follow-up in the AVF ligation observational cohort from our original RCT published in 2019. Results were compared with CMR at 6 months postintervention. The coprimary end point was the change in CMR-derived LVM and LVM index at long-term follow-up from imaging at 6 months postindex procedure. Results At a median of 5.1 years (interquartile range, 4.7-5.5 years), 17 patients in the AVF ligation group were studied with repeat CMR with a median duration to follow-up imaging of 5.1 years (IQR, 4.7-5.5 years). Statistically significant further reductions in LVM (-17.6±23.0 g, P=0.006) and LVM index (-10.0±13.0 g/m2, P=0.006) were documented. Conclusions The benefit of AVF ligation on LVM and LVM index regression appears to persist long term. This has the potential to lead to a significant reduction in cardiovascular mortality.
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Affiliation(s)
- Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas J. Montarello
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Nishant Juneja
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Michael B. Stokes
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Daniel J. Scherer
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kerry F. Williams
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Santosh A. Olakkengil
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Robert P. Carroll
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen S.L. Teo
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Stephen P. McDonald
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Patrick T. Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nitesh N. Rao
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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The attitude of kidney transplant recipients towards elective arteriovenous fistula ligation. PLoS One 2020; 15:e0234931. [PMID: 32615582 PMCID: PMC7332306 DOI: 10.1371/journal.pone.0234931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022] Open
Abstract
Background Arteriovenous fistulas (AVF) are a source of various complications. Among previously hemodialyzed kidney transplant recipients (KTxR), the AVF may persist over time. The patients’ decisions whether to ligate the functioning AVF may be prompted by many factors. Our knowledge of benefits concerning the procedure as well as patients' attitude towards it is scarce. Aim Evaluation of the patients’ opinion on the persistent AVF ligation after a successful kidney transplantation. Materials and methods An anonymous survey was carried out among 301 previously hemodialyzed KTxR. The patients were recruited during scheduled visits in the Transplantation Outpatient Unit. All subjects completed an anonymous questionnaire including questions about their attitude towards the matter in question. Results 69 patients (22.9%) have considered AVF closure. The most common causes for such attitude were esthetic reasons (n = 29) and concerns about heart health (n = 13). Among those 69 subjects, 18 have presented with symptomatic AVF due to multiple symptoms. Symptomatic AVFs were localized on the forearm in 14 out of 18 cases. As many as 116 (38.5%) cases have never wanted to ligate the AVF and 116 (38.5%) subjects did not have a clear opinion. In our study we report 158 (52.5%) cases of non-functioning AVFs. The main reason for the above was spontaneous AVF thrombosis (121 cases). Only 24 subjects reported to rely on the physician-provided information about the AVF management. Conclusions One fourth of KTRs have ever considered AVF ligation. There is a distinct need for educating patients on the possibilities of post-transplantation AVF management.
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