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Kidney Week

Abstract: PO1025

Vascular Access in Kidney Transplant Patients with Allograft Failure Returning to Hemodialysis

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Fisher, Molly, Montefiore Medical Center, Bronx, New York, United States
  • Gone, Anirudh Reddy, Montefiore Medical Center, Bronx, New York, United States
  • Mathew, Linda, Montefiore Medical Center, Bronx, New York, United States
  • Jobson, Crystal K., Montefiore Medical Center, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Bronx, New York, United States
  • Mokrzycki, Michele H., Montefiore Medical Center, Bronx, New York, United States
  • Johns, Tanya S., Montefiore Medical Center, Bronx, New York, United States
Background

Central vein catheters (CVC) are the predominant vascular access (VA) in incident hemodialysis (HD) patients and are associated with worse outcomes compared to arteriovenous (AV) access. Limited data exist on VA type and association with outcomes in kidney transplant recipients (KTR) with allograft failure. We aimed to determine factors associated with VA type among KTR with allograft failure who return to HD.

Methods

We performed a retrospective study of 147 KTR >18 years with allograft failure between 2010-2021 at an academic hospital in the Bronx, NY. KTR with immediate allograft failure or <1 month of HD following allograft failure were excluded. Data was collected on pre-transplant dialysis modality, vintage, and VA type. Data at allograft failure included sociodemographics, comorbidities, clinic visits, VA type. Descriptive analyses and logistic regression were performed to evaluate factors associated with VA among KTR who return to HD.

Results

At allograft failure, mean age was 53 years (SD 15), 62% were men and 46% were of Black race. Pre-transplant, 91.8% patients were on HD, 2.7% were on peritoneal dialysis (PD), and 5.5% were not on dialysis. Mean vintage was 4.6 years (SD 4.4). Pre-transplant VA included AV access in 87.7% and CVC in 4.1% of patients. At allograft failure, 82.3% and 17.7% KTR initiated HD with an AV access and CVC, respectively. Compared to pre-transplant HD patients, those on PD or who received a preemptive transplant were less likely to initiate HD with an AV access at time of allograft failure (80.6% vs 50% vs 12.5%, p<0.001). KTR were 19% less likely to initiate HD with an AV access for each year increase between the time of transplant and allograft failure (OR 0.81, 95% CI 0.69-0.94). Sociodemographics, comorbidities and number of clinic visits 1 year prior to allograft failure were not associated with VA. One year mortality was 10.7% in KTR initiating HD with a CVC vs 3.4% in those with an AV access (p=0.12).

Conclusion

The majority of KTR with allograft failure returned to HD with an AV access. CVC use was higher in those with longer allograft survival, previously on PD or who received a preemptive transplant, highlighting a need for transition of care optimization. Larger studies are needed to determine if VA type is associated with mortality in this population.