Impact of Dialysis Access Fistula on Cardiac Function After Kidney Transplantation

Introduction. The cardiovascular impact of a patent arteriovenous fistula (AVF) following kidney transplantation has not been clearly described. This study aimed to evaluate the natural history of AVFs in kidney transplant recipients and the effect of spontaneous AVF closure after kidney transplantation on cardiac status. Materials and methods. Data on vascular access for dialysis were collected from medical charts of kidney transplant recipients between July 2009 and November 2010 at a single center. Echocardiographic re-assessment of the AVF flow and cardiac status was done in selected patients with functioning and nonfunctioning AVFs. Results. Of 180 kidney transplant recipients, 142 had AVFs before transplantation and 99 (69.7%) had a functioning fistula at the time of study after kidney transplantation. Twenty-three patients with a functioning AVF were compared with 17 with spontaneously closed AVFs. The left ventricular ejection fraction improved in both groups posttransplant. In the group with patent fistulas, there was a trend towards lower value of left ventricular endsystolic and end-diastolic diameters, but it did not reach statistical significance. The mean fistula flow was 560 +/- 405 mL/min in this group. A significant reduction was observed in the interventricular septum and left ventricular posterior wall diameters in the group with closed AVFs. Conclusions. Spontaneous AVF closure did not offer a significant cardiac beneficial effect. There are insufficient data to promote systematic closure of AVF after successful kidney transplantation.