Management of vascular access for hemodialysis after successful kidney transplantation.
OBJECTIVE
There is a lack of data concerning the fate of arterio-venous fistulas (AVF) after successful kidney transplantation. The objective of this study was to assess the evolution of AVF in transplanted patients and to discuss the management of such vascular access once dialysis has been stopped.


METHODS
We reviewed 160 renal transplant patients who had undergone an AVF 0 to 312 months (mean 29) before transplantation. 136 (85%) of AVF were created in the forearm/wrist region and 21 (13%) at the elbow.


RESULTS
The mean follow-up was 69 months from renal transplantation and 95 months from constitution of the AVF. Vascular access had to be closed in 7.5% of cases. Thrombosis occurred in 31% of cases, mainly in distal fistulas (85%). AVF was still functional in 61% of patients at the end of follow-up.


CONCLUSIONS
AVF remains functional in the majority of patients after renal transplantation and is not usually associated with any significant morbidity. Systematic closure of AVF does not seem warranted as it would deprive patients of a useful vascular access should dialysis become again necessary in the long term.
Patard
Jean-Jacques
JJ
Department of Urology, CHU Pontchaillou, Rennes, France. jean-jacques.patard@chu-rennes.fr
Bensalah
Karim
K
Lucas
Antoine
A
Rodriguez
Alejandro
A
Manunta
Andrea
A
Rivalan
Joseph
J
Le Pogamp
Patrick
P
Lobel
Bernard
B
Guillé
François
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011184:Postoperative Period; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D013927:Thrombosis / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014654:Vascular Patency