There is no consensus on whether to ligate or preserve uncomplicated vascular access (VA) after kidney transplantation (KT), as International Guidelines do not address this issue. Enhanced survival rates of kidney grafts may elevate the risk of cardiac morbidity and mortality due to prolonged exposure to the hemodynamic effects of arterio-venous fistulas (AVF). Although VA ligation reduces left ventricle (LV) mass, its impact on cardiovascular (CV) morbidity or mortality is unclear. High-flow VAs can complicate KT patients, and immunosuppressive medication may increase these complications. Despite preserving VA for future hemodialysis (HD) use, central catheters are used in nearly two-thirds of patients. Detecting transplant patients who can undergo AVF ligation and reconstruction when returning to HD allows for flexible decision-making with a multidisciplinary approach, personally tailored to patients at their discretion. Therefore, an algorithm involving Doppler ultrasound and cardiac evaluation is advisable.

Complex Cardiovascular Center General University Hospital 1st Medical Faculty Charles University Prague Czechia

Department of CLINTEC Division of Renal Medicine Karolinska Institutet and Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Leiden University Medical Center Leiden Netherlands

Department of Medical and Surgical Sciences University of Foggia Foggia Italy

Department of Nephrology and Kidney Transplantation Hospital Clínic of Barcelona Barcelona Spain

Department of Nephrology Clinical Hospital Center Zemun Belgrade Serbia

Department of Surgery Demiroglu Bilim University Florence Nightingale Hospital Istanbul Türkiye

Department of Surgery University of Cambridge London United Kingdom

European Kidney Transplant Association Section of European Society of Transplantation Amsterdam Netherlands

Faculty of Medicine University of Belgrade Belgrade Serbia

Vascular Access Society Maastricht Netherlands

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Transpl Int. 2026 Jan 09;38:16128. doi: 10.3389/ti.2025.16128. PubMed

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