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Ann Vasc Surg. 2019 Sep 16. pii: S0890-5096(19)30710-1. doi: 10.1016/j.avsg.2019.06.040. [Epub ahead of print]

To ligate or not to ligate: a meta-analysis of cardiac effects and allograft function following arteriovenous fistula closure in renal transplant recipients.

Author information

1
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China; National Key Clinical Department of Kidney Diseases, Zhejiang, China; Institute of Nephrology, Zhejiang University, Zhejiang, China; The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China; Department of Nephrology, Dongyang People's Hospital, Zhejiang, China.
2
Department of Nephrology, Dongyang People's Hospital, Zhejiang, China.
3
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China; National Key Clinical Department of Kidney Diseases, Zhejiang, China; Institute of Nephrology, Zhejiang University, Zhejiang, China; The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China.
4
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China; National Key Clinical Department of Kidney Diseases, Zhejiang, China; Institute of Nephrology, Zhejiang University, Zhejiang, China; The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China. Electronic address: wujianyong1964@zju.edu.cn.

Abstract

OBJECTIVES:

There are no available guidelines regarding preserving or ligating an arteriovenous fistula following successful kidney transplantation. Therefore, we performed a meta-analysis to formulate a clear opinion regarding the status of arteriovenous fistula in renal allograft recipients.

PATIENTS AND METHODS:

We performed an electronic literature search of PubMed, Embase, and the Cochrane Library for eligible studies up to January 2019. We aimed to systematically evaluate cardiac systolic and diastolic function and allograft function after arteriovenous fistula closure. The primary outcome was the differences in left ventricular mass index, left ventricular end-diastolic diameter, ejection fraction and serum creatinine levels between patients with occluded arteriovenous fistula vs patent arteriovenous fistula.

RESULTS:

Renal transplant recipients with occluded arteriovenous fistula had lower left ventricular mass index values and left ventricular end-diastolic diameter compared with those with patent arteriovenous fistula. The pooled mean differences were 21.67 (95% CI: 19.94 to 23.39; p<0.001) and 2.75 (95% CI: 1.47 to 4.04; p<0.001), respectively. Patients with occluded arteriovenous fistula also had lower serum creatinine levels vs those with patent arteriovenous fistula. The pooled mean difference was 0.10 (95% CI: 0.04 to 0.17; p=0.003). We saw no difference regarding ejection fraction between the groups. The pooled mean difference was 0.84 (95% CI: -0.85 to 2.53; p=0.33).

CONCLUSION:

Our meta-analysis demonstrated that arteriovenous fistula closure improves cardiac morphology and has better kidney graft function. Arteriovenous fistula closure may be considered in patients with a well-functioning allograft.

KEYWORDS:

arteriovenous fistula; kidney transplantation; left ventricular mass index

PMID:
31536798
DOI:
10.1016/j.avsg.2019.06.040

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