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Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients

Nitesh N Rao1,2,3, Michael B Stokes4, Adil Rajwani4,5

  • 1Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.).

Circulation
|May 3, 2019
PubMed

Insights

Ligating arteriovenous fistulas (AVFs) after kidney transplant significantly reduces left ventricular mass. This intervention offers a potential strategy to improve cardiovascular health in transplant recipients.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation Medicine

Background:

  • High cardiovascular morbidity and mortality persist in kidney transplant recipients.
  • Patent arteriovenous fistulas (AVFs) may contribute to maladaptive cardiovascular remodeling post-transplant.
  • The potential for AVF ligation to reverse this remodeling is unknown.

Purpose of the Study:

  • To evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients.
  • To determine if AVF ligation can reverse maladaptive cardiovascular remodeling.

Main Methods:

  • A randomized controlled trial involving kidney transplant recipients with stable graft function (>12 months post-transplant).
  • Participants were randomized to AVF ligation or no intervention.
  • Cardiac magnetic resonance imaging was used at baseline and 6 months to assess left ventricular (LV) mass, volumes, atrial areas, ejection fraction, NT-proBNP, cardiac output, and brachial flows.

Main Results:

  • AVF ligation significantly reduced LV mass by 22.1 g compared to a small increase in the control group (P<0.001).
  • Significant decreases were observed in LV volumes, cardiac output, atrial volumes, and NT-proBNP levels post-ligation (P<0.01).
  • No significant changes in LV ejection fraction or pulmonary artery velocity were noted; no complications or changes in renal function/blood pressure were observed.

Conclusions:

  • Elective ligation of a patent AVF in stable kidney transplant recipients leads to a clinically significant reduction in left ventricular myocardial mass.
  • AVF ligation is a safe procedure with no adverse effects on renal function or blood pressure.
  • This study provides evidence for AVF ligation as a therapeutic strategy to mitigate cardiovascular remodeling in kidney transplant patients.
Abstract

Keywords:
arteriovenous fistulaheart ventricleskidney transplantationmagnetic resonance imaging

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