Abstract: FR-PO772
Keep or Remove? Arteriovenous Fistula Functionality in Patients Returning to Haemodialysis after Transplant Failure
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Blakey, Sarah, Imperial College Healthcare NHS Trust, London, United Kingdom
- Ashby, Damien, Imperial College, London, United Kingdom
Background
The arteriovenous fistula is the preferred access type for haemodialysis patients, but following transplantation many patients are concerned about the appearance or potential for long-term complications with a fistula, particularly since it may no longer be functional should dialysis be required years later. Little is known about the long-term patency of fistulae when redundant, or the likelihood of functionality at the point of transplant failure.
Methods
In a prospectively identified cohort of haemodialysis patients with a fistula undergoing renal transplantation between April 2007 and October 2015, records were retrospectively analysed to identify those who returned to hemodialysis, and their vascular access at the time.
Results
Out of 224 patients (aged 19-77 at transplantation, 75.4% male) followed for up to 10 years (mean 49.1 months), 24 (10.7%) died with a functioning transplant and 21 (9.4%) returned to haemodialysis after a mean of 34.3 months post-transplantation (range 0-85.5). Of the 21 patients returning to haemodialysis, 15 (71.4%) were able to use their pre-transplant fistula.
Compared to those returning to dialysis with a functional fistula, those requiring new access had a longer transplant duration (66.6 vs 21.3 months, p=0.007), but there was no difference in age at transplant failure (47.8 vs 56.1, p=0.2). All patients re-starting haemodialysis within 24 months of transplantation had a functional fistula, compared to only 40% of those returning to dialysis beyond 2 years.
Of the 6 patients whose fistula was non-functional, 3 had undergone excision due to fistula complications (2 aneurysms and 1 high-output heart failure), 2 spontaneously failed, and 1 required alternative access whilst a procedure was performed to recover fistula functionality.
Conclusion
Following a period of haemodialysis via fistula and subsequent transplantation, around 10% of patients return to dialysis over 4 years. The majority of these will still have functional access, but fistula patency declines with time, due to fistula complications and spontaneous failure. These data may be helpful to those making fistula decisions with transplant patients.