Long-term outcomes after kidney transplantation in patients with the history of hemodialysis vascular access thromboses

Introduction: Thrombosis of hemodialysis arterio-venous fistulas
(AVF) are frequently associated with co-morbid conditions that may
impact also post-transplant outcomes in those patients. The aim of this
study was to analyse the rate of post-transplant complications and
outcomes depending on the results of AVF surgery.
Materials and Methods: This study included all patients who passed
AVF surgery and then deceased donor renal transplantations performed
in a single centre between January 1, 2004 and December 31, 2007,
and where patients were available for 8-year follow-up. All cases were
divided into two groups according to AVF surgery outcomes: AVF
thrombosis group (group A, n = 53) and group with primarily
functioning AVF (control, group B, n = 94). Groups were compared for
frequency of post-transplant complications and outcomes (surgical
complications, development of delayed graft function, acute rejections,
chronic graft dysfunction, graft losses and patient deaths).
Results and Discussion: AVF thrombosis was observed in 36% of
cases. Analysis of association with demographical and clinical features
showed association only with female gender (66% vs. 44% in group B,
p < 0.05).
Analysis of post-transplant complications showed similar rate of
vascular and urological complications in group A and B (18.9 vs. 18.1%
and 5.7 vs. 7.4%, respectively, p = NS). Patients in group A had higher
rate of chronic graft dysfunction (63,3 vs. 34.8%, p < 0.05) and
relatively higher rates of delayed graft function and acute rejections
(26.4 vs. 16.0% and 37.7 vs. 29.8%, respectively, p = NS), significantly
higher rates of graft losses and patient deaths (43.4 vs 19.1%, and 32.1
vs. 17.0%, p < 0.05).
Kaplan-Meyer survival analysis showed that patients in group A had
lower graft survival and patient survival (p < 0.05 for both) [Figure 1].
Analysis in groups revealed different factors associated with graft
losses: in group A graft losses were associated with diabetes mellitus
diagnosis (26.1 vs. 3.3%) and younger patient age (35.3 + 14.1 vs. 44.7
+ 10.8 yy) (p < 0.05 for both); and in group B – with development of
urological complications after transplantation (22.2 vs. 3.9%) and
higher serum creatinine level at discharge after transplantation (162 +
109 vs. 118 + 27 mkmol/l) (p < 0.05 for both), as also relatively higher
rate of graft losses in cases when there was need for kidney graft
vascular reconstruction at ”back-table” (83.3 vs. 60.8%, p = 0.060) and
allocation “female donor – male recipient” (38.9 vs. 19.7%, p = 0.082).
Conclusion: Results show that pre-transplant complications associated
with AVF surgery may indicate higher risk of development of
complications also after kidney transplantation, including graft losses
and patient deaths. These patients may need more prolonged
anticoagulant therapy and coagulation control after transplantation,
especially diabetic and young patients with history of multiple
hemodialysis vascular access thromboses.