Management of dialysis access in the post-transplantation patient

Arteriovenous fistula (AVF) is the preferred access for hemodialysis in patients with end-stage renal disease, and arteriovenous grafts are used when AVF creation is not feasible. Post renal transplantation, hemodialysis may be needed due to delayed graft function or transplantation failure. This review aimed to summarize current evidence on the impact of maintaining versus ligating AV access on renal function and cardiovascular outcomes post transplantation. A comprehensive review of literature was conducted, analyzing studies on the effects of AVF and AV graft maintenance or ligation on renal and cardiovascular outcomes in patients post transplantation. Evidence indicates that maintaining AVF post transplantation is associated with higher estimated glomerular filtration rate and better renal function retention, but poses risks for cardiovascular complications, such as left ventricular hypertrophy. Ligation of AVF is linked to improved cardiovascular outcomes, including reduced N-terminal pro-B-type natriuretic peptide levels, but may lead to a greater decline in estimated glomerular filtration rate. No significant difference in long-term renal allograft survival was observed between maintaining and ligating AV access. The decision to maintain or ligate AV access in patients post renal transplantation should be individualized, considering both renal function preservation and cardiovascular health. Although maintaining AVF may benefit renal function, it poses cardiovascular risks, whereas ligation can mitigate these risks without significantly affecting allograft survival.