Abstract: PUB739
Association between Vascular Access Type in Hemodialysis Patients and Subsequent Kidney Transplant Outcomes
Session Information
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Airy, Medha, Baylor College of Medicine, Houston, Texas, United States
- Lenihan, Colin R., Stanford University School of Medicine, Palo Alto, California, United States
- Wasse, Monnie, Rush University Medical Center, Chicago, Illinois, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background
Type of vascular access is associated with outcomes in patients with end-stage kidney disease undergoing hemodialysis. Whether associations exist with outcomes after kidney transplant is unknown. Potential mechanisms towards worse outcomes include patency of residual peripheral accesses potentially contributing to heart failure as well as retained vascular grafts that may cause chronic inflammation.
Methods
A retrospective cohort study of hemodialysis patients receiving a first kidney transplant was done using merged data from the US Renal Data System and a large dialysis organization. We ascertained the access used for the last hemodialysis prior to transplantation: arteriovenous fistula (AVF); arteriovenous graft (AVG); central venous catheter (CVC). Patients were followed from kidney transplant for all-cause mortality, kidney allograft loss from any cause, and allograft loss not from death.
Results
Among 9291 patients who underwent kidney transplantation between 2006-2011, 65.3% had an AVF and 20.4% had an AVG and 14.3% used a CVC. Cox proportional hazards regression models adjusted for demographic, comorbidity, and transplant characteristics, as well as laboratory parameters indicated no associations between vascular access type and all-cause mortality or all-cause allograft loss (Table). Central venous catheter use was associated with a 30% higher risk of allograft loss from causes other than death compared to use of an arteriovenous fistula (HR=1.30; 95% CI, 1.06-1.57).
Conclusion
No clear associations between vascular access use for dialysis and subsequent transplant outcomes were identified. The association of central venous catheter use with allograft loss from all causes other than death lacks a plausible explanation and requires confirmation.
| *Adjusted HR (95% CI) | AVG vs AVF | CVC vs AVF |
| All-cause mortality | 1.13 (0.97, 1.33) | 1.00 (0.83, 1.21) |
| Allograft loss | 1.13 (1.00, 1.28) | 1.12 (0.96, 1.29) |
| Allograft loss from cause other than death | 1.17 (0.98, 1.39) | 1.30 (1.06, 1.57) |
*Adjusted for demographic variables, comorbidities, transplant characteristics, and laboratory parameters