Arteriovenous fistula (AVF) is the best method of vascular access for hemodialysis. This approach can lead to several complications, such as hyperkinetic heart failure due to a hyperfunctional AVF or dilatation of the feeding artery. These are late complications, especially in patients after a successful kidney transplantation. An observational study was performed focusing on patients more than 12 months after kidney transplantation. The AVF was evaluated by ultrasound and, if the outflow exceeded 1.5 L/min, an echocardiogram was performed. Surgical management was indicated if the cardiac index was higher than 3.9 L/min/m2 or upon finding a brachial artery aneurysm. A total of 208 post- kidney transplantation patients were examined over a 3-year period, of which 46 subjects (22.11%) had hyperfunctional AVF and 34 cases (16.34%) of feeding artery dilatation were determined. In total, 40 AVF flow reduction and 6 AVF ligation procedures were performed. The median AVF flow before and after the reduction was 2955 mL/min and 1060 mL/min, respectively. Primary patency after flow reduction was 88.3% at 12 months. Late AVF complications in patients following kidney transplantation are quite common. It is necessary to create a screening program to monitor AVFs in these patients.

2nd Department of Surgery University Hospital Olomouc Olomouc Czechia

3rd Department of Internal Medicine University Hospital Olomouc Olomouc Czechia

Faculty of Medicine Palacký University in Olomouc Olomouc Czechia

See more in PubMed

Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic Review: Kidney Transplantation Compared WITH Dialysis in Clinically Relevant Outcomes. Am J Transplant (2011) 11(10):2093–109. 10.1111/j.1600-6143.2011.03686.x PubMed DOI

Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis (2020) 75(4):S1–164. 10.1053/j.ajkd.2019.12.001 PubMed DOI

Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N. The Relationship Between the FLOW of Arteriovenous Fistula and Cardiac Output In Haemodialysis Patients. Nephrol Dial Transplant (2007) 23(1):282–7. 10.1093/ndt/gfm549 PubMed DOI

Stern AB, Klemmer PJ. High‐Output Heart Failure Secondary To Arteriovenous Fistula. Hemodialysis Int (2011) 15(1):104–7. 10.1111/j.1542-4758.2010.00518.x PubMed DOI

Ferreira SRC, Moisés VA, Tavares A, Pacheco-Silva A. Cardiovascular Effects of Successful Renal Transplantation: A 1-YEAR Sequential Study of LEFT Ventricular Morphology and Function, and 24-HOUR Blood Pressure Profile. Transplantation (2002) 74(11):1580–7. 10.1097/00007890-200212150-00016 PubMed DOI

Cridlig J, Selton-Suty C, Alla F, Chodek A, Pruna A, Kessler M, et al. Cardiac Impact of the Arteriovenous Fistula After Kidney Transplantation: A Case-Controlled, Match-Paired Study. Transpl Int (2008) 21(10):948–54. 10.1111/j.1432-2277.2008.00707.x PubMed DOI

Abreo K, Sachdeva B, Abreo AP. To Ligate Or Not To Ligate Hemodialysis Arteriovenous Fistulas In Kidney Transplant Patients. J Vasc Access (2020) 22:942–6. 10.1177/1129729820970786 PubMed DOI

Voorzaat BM, Janmaat CJ, Wilschut ED, Van Der Bogt KE, Dekker FW, Rotmans JI. No Consensus On Physicians’ Preferences On Vascular Access Management After Kidney Transplantation: Results Of A Multi-National Survey. J Vasc Access (2019) 20(1):52–9. Available from:. 10.1177/1129729818776905 PubMed DOI PMC

Malik J, Valerianova A, Tuka V, Trachta P, Bednarova V, Hruskova Z, et al. The Effect of High‐Flow Arteriovenous Fistulas On Systemic Haemodynamics and Brain Oxygenation. ESC Heart Fail (2021) 8:2165–71. 10.1002/ehf2.13305 PubMed DOI PMC

Valerianova A, Malik J, Janeckova J, Kovarova L, Tuka V, Trachta P, et al. Reduction of Arteriovenous Access Blood FLOW Leads To Biventricular Unloading In Haemodialysis Patients. Int J Cardiol (2021) 334:148–53. 10.1016/j.ijcard.2021.04.027 PubMed DOI

Manca O, Pisano GL, Carta P, Manca EM, Piredda GB, Pili G, et al. The Management of Hemodialysis Arteriovenous Fistulas In WELL Functioning Renal Transplanted Patients: MANY Doubts, Few Certainties. J Vasc Access (2005) 6(4):182–6. 10.1177/112972980500600405 PubMed DOI

Aitken E, Kingsmore D. The FATE of the Fistula Following Renal Transplantation. Transpl Int (2014) 27(9):e90–1. 10.1111/tri.12326 PubMed DOI

Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency Rates of the Arteriovenous Fistula for Hemodialysis: A Systematic Review and Meta-Analysis. Am J Kidney Dis (2014) 63(3):464–78. 10.1053/j.ajkd.2013.08.023 PubMed DOI

Weekers L, Vanderweckene P, Pottel H, Castanares-Zapatero D, Bonvoisin C, Hamoir E, et al. The Closure of Arteriovenous Fistula In Kidney Transplant Recipients Is Associated WITH An Acceleration Of Kidney Function Decline. Nephrol Dial Transplant (2016) gfw351. 10.1093/ndt/gfw351 PubMed DOI

Dubin AH, Martin-Velez J, Shenkute NT, Toledo AH. Long-Term Safety, Efficacy, Indications, and Criteria of Arteriovenous Fistula Ligation Following Kidney Transplant: A Patient-Driven Approach. Exp Clin Transplant (2023) 21(6):487–92. 10.6002/ect.2023.0024 PubMed DOI

Janeckova J, Bachleda P, Koleckova M, Utikal P. Brachial Artery Aneurysm As A LATE Complication of Arteriovenous Fistula. J Vasc Access (2023) 24(5):926–32. 10.1177/11297298211059326 PubMed DOI

Yaffe HC, Greenstein SM. Should Functioning AV Fistulas Be Ligated After Renal Transplantation? J Vasc Access (2012) 13(4):405–8. 10.5301/jva.5000086 PubMed DOI

Wilmink T, Hollingworth L, Dasgupta I. Access Ligation in Transplant Patients. J Vasc Access (2016) 17(1_suppl):S64–8. 10.5301/jva.5000537 PubMed DOI

Amerling R, Ronco C, Kuhlman M, Winchester JF. Arteriovenous Fistula Toxicity. Blood Purif (2011) 31(1–3):113–20. 10.1159/000322695 PubMed DOI

Roca-Tey R, Arcos E, Comas J, Tort J. Haemodialysis Access Profile In Failed Kidney Transplant Patients: Analysis of DATA FROM the Catalan Renal Registry (1998–2016). J Vasc Access (2024) 25(2):490–7. 10.1177/11297298221118738 PubMed DOI

Balaz P, Rokosny S, Klein D, Adamec M. Aneurysmorrhaphy Is An Easy Technique For Arteriovenous Fistula Salvage. J Vasc Access (2008) 9(2):81–4. 10.1177/112972980800900202 PubMed DOI

Baláž P, Rokošný S, Bafrnec J, Whitley A, O’Neill S. Repair of Aneurysmal Arteriovenous Fistulae: A Systematic Review and Meta-Analysis. Eur J Vasc Endovascular Surg (2020) 59(4):614–23. 10.1016/j.ejvs.2019.07.033 PubMed DOI

Balaz P, Rokosny S, Klein D, Adamec M. Aneurysmorrhaphy Is An EASY Technique For Arteriovenous Fistula Salvage. J Vasc Access (2008) 9(2):81–4. 10.1177/112972980800900202 PubMed DOI

Rokošný S, Baláž P, Wohlfahrt P, Palouš D, Janoušek L. Reinforced Aneurysmorrhaphy for TRUE Aneurysmal Haemodialysis Vascular Access. Eur J Vasc Endovascular Surg (2014) 47(4):444–50. 10.1016/j.ejvs.2014.01.010 PubMed DOI

MacRae JM, Pandeya S, Humen DP, Krivitski N, Lindsay RM. Arteriovenous Fistula-Associated High-Output Cardiac Failure: A Review Of Mechanisms. Am J Kidney Dis (2004) 43(5):e17–e22. 10.1053/j.ajkd.2004.01.016 PubMed DOI

Kanno T, Kamijo Y, Hashimoto K, Kanno Y. Outcomes of Blood FLOW Suppression Methods of Treating HIGH FLOW Access in Hemodialysis Patients WITH Arteriovenous Fistula. J Vasc Access (2015) 16(10_suppl):S28–33. 10.5301/jva.5000415 PubMed DOI

Agarwal R. Prevalence, Determinants and Prognosis of Pulmonary Hypertension Among Hemodialysis Patients. Nephrol Dial Transplant (2012) 27(10):3908–14. 10.1093/ndt/gfr661 PubMed DOI PMC

Gkotsis G, Jennings WC, Malik J, Mallios A, Taubman K. Treatment of HIGH FLOW Arteriovenous Fistulas After Successful Renal Transplant Using a Simple Precision Banding Technique. Ann Vasc Surg (2016) 31:85–90. 10.1016/j.avsg.2015.08.012 PubMed DOI

Leskovar B, Furlan T, Poznic S, Hrastelj M, Adamlje A. Using CorMatrix for Partial and Complete (Re)Construction of Arteriovenous Fistulas in Haemodialysis Patients: (Re)Construction of Arteriovenous Fistulas WITH CorMatrix. J Vasc Access (2019) 20(6):597–603. 10.1177/1129729819826032 PubMed DOI