Vascular access outcomes as a predictor of development of chronic allograft nephropathy

The vascular condition influences the outcomes of arteriovenous fistula (AVF) surgery. However, it has not been established how it influences the outcomes of renal transplantation and the development of chronic allograft nephropathy (CAN). The aim of this study was to define the relationship between AVF failure in the pretransplant period and the development of CAN.

In this study we included all patients who underwent AVF surgery and then first kidney allotransplantations from January 1, 1999 to December 31, 2002. Patients were divided into two groups according to the AVF surgery outcomes: group 1 (n = 45, mean age 50 +/- 13 years, male/female ratio 27/18) had no vascular access complications and were dialysed through a native AVF. Group 2 (n = 39, mean age 51 +/- 11 years, male/female ratio 17/22) had additional interventions due to AVF failure. We analyzed the incidence of CAN in both groups.

During the follow-up period CAN was observed in five patients in group 1 and 11 patients in group 2 (11,1% vs 28,2%, P < .05). There was a statistically significant relationship between CAN and acute rejection episodes (P < .005) and diabetes mellitus (P < .05).

Failures of arteriovenous fistulas in hemodialysis patients were associated with an increased incidence of CAN in the posttransplant period.