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Abstract: SA-OR006

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

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Rao, Nitesh Nikilesh, University Of Adelaide, Adelaide, South Australia, Australia
  • McDonald, Stephen P., Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Faull, Randall James, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Coates, Patrick Toby, University of Adelaide, Adelaide, South Australia, Australia

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