Should functioning AV fistulas be ligated after renal transplantation?

Area of Science:

• Nephrology
• Vascular Surgery
• Transplantation Medicine

Background:

• Physicians lack clear guidelines for managing vascular accesses in renal transplant recipients.
• Arteriovenous fistulas (AVFs) are common in patients undergoing renal dialysis and transplantation.
• Decisions regarding AVF ligation in successful transplant patients are frequent and impactful.

Purpose of the Study:

• To review existing literature on arteriovenous fistula (AVF) management post-renal transplant.
• To establish guidelines for deciding whether to maintain or ligate AVFs in successful renal transplant patients.
• To address the frequent clinical question of AVF status after successful renal transplantation.

Main Methods:

• Comprehensive review of the medical literature.
• Inclusion of anecdotal clinical experience from the authors.
• Analysis of data considering 10-year adjusted renal transplant graft survival rates.

Main Results:

• The impact of AVF ligation on transplant patient cardiac morphology and function remains unclear.
• Persistent AVFs do not appear to negatively affect patient or graft survival.
• Emergent AVF closure is indicated for severe venous hypertension, pseudoaneurysm rupture risk, high-output cardiac failure, or ischemic hand.

Conclusions:

• Functioning AVFs in successful renal transplant recipients should rarely be ligated.
• Routine AVF ligation is not supported by current evidence due to potential future need for dialysis.
• Physiological impact of patent AVFs does not warrant routine ligation post-transplant.