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

Janis Jushinskis, Vadims Suhorukovs, Ieva Ziedina, Aleksandrs Malcevs, Inese Jurkane, Viktors Shevelevs, Rafail Rozental

    Research output: Contribution to journalMeeting Abstractpeer-review

    Abstract

    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.
    Original languageEnglish
    Article numberP.1277
    Pages (from-to)S593-S593
    JournalTransplantation
    Volume100
    Issue number7, Suppl.1
    Publication statusPublished - Jul 2016
    Event26TH CONGRESS OF THE TRANSPLANTATION SOCIETY : TTS 2016 - Hong Kong, Hong Kong
    Duration: 18 Aug 201623 Aug 2016

    Field of Science*

    • 3.2 Clinical medicine

    Publication Type*

    • 3.3. Publications in conference proceedings indexed in Web of Science and/or Scopus database

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