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Kidney Week

Abstract: PO2120

AV Fistula Leading to High-Output Cardiac Failure in a Kidney Transplant Population: Our Experience

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Ahmad, Yahya Rauf, University of Kentucky, Lexington, Kentucky, United States
  • Fattah, Hasan, University of Kentucky, Lexington, Kentucky, United States

Among kidney allograft recipients, cardiovascular death continues to remain the major cause of mortality. Arteriovenous (AV) fistula is the optimal access for most end stage kidney disease (ESKD) patients. AV fistula can lead to hemodynamically significant left-to-right sided shunting resulting in permanent structural and functional cardiac changes. We herein reviewed our center cases of high cardiac-output cardiac failure secondary to AV fistula who were followed up after surgical intervention.


Retrospective chart review was performed on kidney transplant patients who had a diagnosis of high output cardiac failure confirmed on right heart catheterization and required AV fistula ligation for symptomatic high output cardiac failure at University of Kentucky.


A total of 595 kidney transplants were performed at University of Kentucky during the study period (January 2015 until May 2021). 19 patients underwent fistula ligation, 7 of them (36.8%) required AV fistula ligation due to high output cardiac failure. Average peak blood flow across the AV fistula that required ligation was 2.8 L/min. Cardiac catheterization showed drop in cardiac output (CO) with AV fistula closure as seen in Figure 1. Improvement in renal functions was notable in most cases as seen in Figure 2. Symptoms of heart failure improved in all 7 patients with no re-admissions for heart failure exacerbation after AV fistula closure, up until writing this data.


High output heart failure from AV fistula is an under recognized entity. Early diagnosis and management is crucial as it can prevent irreversible changes in cardiac and renal physiology and improve quality of life.

Figure 1

Figure 2