Kidney Week

Abstract: SA-OR006

Favorable Cardiac Remodeling Following Ligation of Arteriovenous Fistula in Stable Renal Transplant Recipients: A Randomized Controlled Study

Session Information

• Access, Organ Utilization, and Infectious Disease
  October 27, 2018 | Location: 24A, San Diego Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Rao, Nitesh Nikilesh, University Of Adelaide, Adelaide, South Australia, Australia

Nitesh Nikilesh Rao, MD



Nitesh Rao is a Consultant Nephrologist at the Northern Adelaide Local Health Network and a clinical senior lecturer of medicine at the University of Adelaide. He was awarded Master of Philosophy in medical science from the University of Adelaide with main research interests in improving cardiovascular outcomes in patients with chronic kidney disease and kidney transplant recipients.

• McDonald, Stephen P., Royal Adelaide Hospital, Adelaide, South Australia, Australia

Stephen P. McDonald,

• Faull, Randall James, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Randall James Faull,

• Coates, Patrick Toby, University of Adelaide, Adelaide, South Australia, Australia

Patrick Toby Coates,

Group or Team Name

• CNARTS

Background

Cardiovascular morbidity and mortality remains high in recipients of kidney transplantation. Persistence of a functional arteriovenous fistula (AVF) post-transplant may contribute to maladaptive cardiovascular remodeling. In this study we aimed to determine whether ligation of AVF would improve myocardial mass in stable kidney transplant recipients, assessed at baseline and 6 months after closure using cardiac magnetic resonance imaging (CMR).

Methods

We recruited 63 adult kidney transplant recipients with stable kidney function and functioning AVF. Participants were randomly assigned to AVF ligation versus no intervention, after a baseline CMR scan followed by a repeat scan six months following AVF ligation. Primary outcome was assessment of left ventricular(LV) mass at 6 months. Secondary outcomes were changes in left and right ventricular volumes, pulmonary flows, left and right atrial areas.

Results

Of the 93 participants assessed for eligibility, 63 eligible participants underwent randomisation: 32 to the intervention and 31 to non-intervention. 54 out of 63 participants completed the study. At the end of 6 months, a decrease of 21.6 gm (95% CI -32.1to -11.0, p<0.001) was observed between the mean LV mass in the AV fistula closure group compared to no significant change in the non-intervention control group. The difference in LV mass index (gm/m²) was a drop by 11.7 gm (95 % CI -17.2 - -6.1, p<0.001) in the intervention group from the baseline versus no change in the control group. Decrease in LV end diastolic volume, LV end systolic volume, right ventricular and bi-atrial volumes were also observed in the AVF closure group. No significant complications were noted after AVF ligation.

Conclusion

Elective ligation of AVF in adults with stable kidney transplantation and functioning AVF is associated with marked reduction in both absolute and indexed measurements of myocardial mass. (Funded by the Royal Adelaide Hospital Research Foundation grant; Australian and New Zealand clinical trials registry, number ACTRN12613001302741)

Funding

• Private Foundation Support