Mobilization of Endothelial Progenitor Cells Following Creation of Arteriovenous Access in Patients with End-Stage Renal Disease.
BACKGROUND
A patent arteriovenous (AV) fistula induces activation of regional vascular endothelium and vascular shear force. Shear stress is an important physiological force in mobilizing endothelial progenitor cells (EPCs). This study aimed to explore the perioperative changes of circulating EPC levels for patients who require hemodialysis and underwent radiocephalic fistula operation.


METHODS
This prospective cohort study included patients who received a radiocephalic fistula surgery when they were between 25 and 65 years of age. The subjects were followed for 90 days postoperatively for any stenotic events or immaturity of the fistula. Blood samples were obtained on the day before surgery and at postoperation day (POD) 3 and 30. CD133+/KDR+ cells, defined as EPCs, were analyzed using flow cytometry. Blood flow of the fistula was followed on POD 3 and 30.


RESULTS
A total of 30 patients were enrolled in the study from July 2009 to December 2011. One patient dropped out of the study and seven patients developed a stenotic (or immature) AV fistula (7/29, 24.1%). There were positive linear relationships between EPC numbers and shear rate postoperatively, which were more significant on POD 30. In addition, postoperative mobilization of EPCs was significantly higher in patients who developed a stenotic fistula than those without.


CONCLUSIONS
The mobilization of circulating EPCs correlated with a compromised arteriovenous fistula. The biological significance of increased EPC numbers need to be determined in future studies.


BACKGROUND
Arteriovenous fistula; Endothelial progenitor cells.
Institute of Clinical Medicine; ; Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University College of Medicine and Hospital; ; Department of Surgery, Tainan Municipal Hospital;
Jun-Neng
JN
Roan
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University College of Medicine and Hospital;
Chwan-Yau
CY
Luo
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University College of Medicine and Hospital;
Mang-Da
MD
Tsai
Department of Surgery, Tainan Municipal Hospital;
I-Shuan
IS
Wu
Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan;
Shih-Wei
SW
Chang
Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan;
Chien-Chi
CC
Huang
Institute of Clinical Medicine;
Yau-Sheng
YS
Tsai
Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan; ; Department of Anesthesiology, Buddhist Tzu-Chi General Hospital and Tzu-Chi University School of Medicine, Hualien, Taiwan.
Chen-Fuh
CF
Lam