To close or not to close: fistula ligation and cardiac function in kidney allograft recipients
Related Experiment Video
Updated: May 21, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Jerzy Głowiński1, Jolanta Małyszko, Irena Głowińska
1Department of Vascular Surgery and Transplantology, Medical University of Bialystok, Białystok, Poland. jerzy.glowinski@wp.pl
Insights
Ligating a well-functioning arteriovenous fistula after kidney transplantation did not improve heart function in a short-term study. Careful consideration is needed before fistula closure due to potential difficulties in creating new dialysis access.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Arteriovenous fistulas are essential for hemodialysis access.
- High-flow fistulas can lead to heart failure.
- The necessity of ligating a functioning fistula post-kidney transplant remains unclear.
Purpose of the Study:
- To evaluate the impact of arteriovenous fistulas on cardiac function in kidney transplant recipients.
- To determine if fistula ligation benefits heart function after successful transplantation.
Main Methods:
- Study included 18 kidney transplant patients.
- 9 patients with patent fistulas were matched with 9 patients who underwent fistula ligation or experienced thrombosis.
- Cardiac function assessed via physical examination and echocardiography.
Main Results:
- No significant differences in cardiac function were observed between patients with patent fistulas and those who underwent ligation or experienced thrombosis.
- Echocardiography 3 months post-fistula closure showed no significant changes from baseline.
Conclusions:
- Fistula ligation in stable kidney transplant recipients does not appear to offer short-term cardiac benefits.
- Decision to ligate a fistula should be made cautiously, considering the challenges of establishing alternative dialysis access.
Introduction:
Arteriovenous fistulas are a preferred access for hemodialysis. Subsequent hemodynamic changes in systemic circulation may cause heart failure. The general conclusions that can be drawn from the few available studies are that high‑flow fistulas causing symptomatic heart failure should be subjected either to reconstruction or ligation. However, it is still unclear whether a well‑functioning fistula should be ligated after successful kidney transplantation.
Objectives:
The aim of our study was to assess the effect of the fistula on heart function in patients after kidney transplantation.
Patients And Methods:
The study included 18 patients after kidney transplantation. Five patients underwent fistula ligation for esthetic reasons; 4 fistulas thrombosed shortly after transplantation. A group of 9 patients with a patent fistula was matched for age and sex. Heart function was assessed by physical examination and echocardiography.
Results:
The study group consisted of 6 women and 3 men, aged 32 to 64 years, with 6 forearm and 3 arm fistulas, and with hemoglobin levels ranging from 6.95 to 9.63 mmol/l. The control group consisted of 6 women and 3 men, aged 38 to 66 years, with 5 forearm fistulas and hemoglobin levels ranging from 7.32 to 9.25 mmol/l. Control echocardiography was performed in each patient 3 months after fistula closure and did not reveal any significant differences compared with baseline examination.
Conclusions:
Fistula ligation performed in a stable kidney allograft recipient does not seem to have a beneficial effect on cardiac function during short-term follow-up. Decision making should be cautious and balanced, because the creation of a new access may be extremely difficult and not always feasible.
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