Abstract: TH-PO908
Harnessing Synergies, Healthy Heart, Allograft Optimized: The Positive Impact of Arteriovenous Fistula (AVF) Closure After Kidney Transplant
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Azeem, Zeeshan, Medical University of South Carolina, Lancaster, South Carolina, United States
- Anand, Prince Mohan, Medical University of South Carolina, Lancaster, South Carolina, United States
Introduction
The AVF remains the preferred vascular access for hemodialysis (HD) and after kidney transplant (KT) for future graft failure but consensus on ligation or preservation of AVF after KT is lacking. While AVF ligation offers established cardiovascular benefits, its impact on allograft function is uncertain with conflicting outcomes (improvement vs deterioration). We present a case of improved allograft function following AVF ligation prompted by symptomatic AVF aneurysm.
Case Description
A 60-year-old male underwent a deceased donor KT for end-stage renal disease secondary to type II diabetes mellitus on 10/03/2022. Prior to a KT patient had a left upper extremity AVF as HD access. Pre-transplant echocardiogram (ECHO) showed an ejection fraction of 60% and mild pulmonary hypertension (RVSP-36mmHg). The postoperative course was complicated by delayed graft function with rapid progressive weight gain despite optimal diuretics with limited salt intake, normal urine output, and elevated creatinine (1. 8-2.4mg/dl- nadir 1.6mg/dl). The immunosuppression regimen was changed from Tacrolimus-based therapy to IV Belatacept without any significant improvement in creatinine. Additionally, worsening swelling at the site of AVF three months post-transplant necessitated a surgical consult. Following AVF ligation due to a symptomatic aneurysm, weight and creatinine improved remarkably accompanied by symptomatic improvement. ECHO and renal allograft resistive indices post-AVF ligation are pending.
Discussion
Our case highlights that risk-benefit assessment of AVF closure after kidney transplantation requires contextual evaluation via a possible scoring system and/or a multi-disciplinary committee to ensure informed decision-making and to optimize primary cardiac and secondary outcomes.