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Shuntligatur nach Nierentransplantation: Pro und Kontra

Arteriovenous fistula ligation after kidney transplantation: pros and cons

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Zusammenfassung

Hintergrund

Ein arteriovenöser Shunt ist der „golden standard“ für den Gefäßzugang bei Patienten mit dialysepflichtiger Niereninsuffizienz. Nach einer erfolgreichen Nierentransplantation wird der Shunt jedoch nicht mehr benötigt. In diesem Artikel möchten wir die kardiovaskulären Vorteile und potenziellen Probleme einer routinemäßigen Shuntligatur nach einer Nierentransplantation erörtern.

Methoden

Es erfolgte eine narrative Literaturrecherche in der Literaturdatenbank von MEDLINE, PubMed und Cochrane Database of Systematic Reviews bis inklusive April 2021.

Ergebnisse und Diskussion

Eine Shuntligatur bei stabilen Nierentransplantatempfängern senkt den pulmonal arteriellen Druck und reduziert das Risiko eines Rechtsherzversagens und bringt damit ein geringeres kardiales Risiko mit sich. Die Entscheidung dazu sollte jedoch vorsichtig und patientenbezogen getroffen werden.

Abstract

Background

An arteriovenous fistula is the gold standard for vascular access in patients with end-stage renal disease necessitating dialysis. After a successful kidney transplantation the fistula is no longer needed. In this article we would like to discuss the cardiovascular benefits and potential problems of routine fistula ligation after kidney transplantation.

Methods

A narrative literature search was performed in the literature database of MEDLINE, PubMed and the Cochrane Database of Systematic Reviews up to April 2021.

Results and conclusion

Closure of arteriovenous fistulas in stable kidney transplant recipients reduces pulmonary artery pressure and reduces the risk of right heart failure and therefore achieves a lower cardiovascular risk; however, the decision should be made carefully and individually for each patient.

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Literatur

  1. Canadian Institute for Health Information (CIHI) (2012) Treatment of End-Stage Organ Failure in Canada. Healthcare Quarterly 15(2):84

    Article  Google Scholar 

  2. Agarwal AK (2015) Systemic effects of hemodialysis access. Adv Chronic Kidney Dis 22(6):459–465

    Article  Google Scholar 

  3. Aitken E, Kerr D, Geddes C, Berry C, Kingsmore D (2015) Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula. J Vasc Access 16(6):459–466

    Article  Google Scholar 

  4. Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N (2008) The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 23(1):282–287

    Article  Google Scholar 

  5. Beigi AA, Sadeghi AM, Khosravi AR, Karami M, Masoudpour H (2009) Effects of the arteriovenous fistula on pulmonary artery pressure and cardiac output in patients with chronic renal failure. J Vasc Access 10(3):160–166

    Article  Google Scholar 

  6. Ahmed BS, Hadj-Abdelkader M, Benezit M, Deteix P, Heng AE, Rosset E (2017) Predictors of autogenous arteriovenous hemodialysis access thrombosis after renal transplantation. Ann Vasc Surg 42:231–237

    Article  Google Scholar 

  7. Bolignano D, Rastelli S, Agarwal R, Fliser D, Massy Z, Ortiz A et al (2013) Pulmonary hypertension in CKD. Am J Kidney Dis 61(4):612–622

    Article  Google Scholar 

  8. Dundon BK, Torpey K, Nelson AJ, Wong DT, Duncan RF, Meredith IT et al (2014) The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. IJNRD 7:337–345

    Google Scholar 

  9. Głowiński J, Małyszko J, Głowińska I, Myśliwiec M (2012) To close or not to close: fistula ligation and cardiac function in kidney allograft recipients. Pol Arch Med Wewn 122(7-8):348–352

    PubMed  Google Scholar 

  10. Hetz P, Pirklbauer M, Müller S, Posch L, Gummerer M, Tiefenthaler M (2020) Prophylactic ligature of AV fistula prevents high output heart failure after kidney transplantation. Am J Nephrol 51(7):511–519

    Article  CAS  Google Scholar 

  11. Letachowicz K, Bardowska K, Królicki T, Kamińska D, Banasik M, Zajdel K et al (2021) The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients. Ren Fail 43(1):113–122

    Article  CAS  Google Scholar 

  12. Loock MT, Bamoulid J, Courivaud C, Manzoni P, Simula-Faivre D, Chalopin JM et al (2010) Significant increase in 1‑year posttransplant renal arterial index predicts graft loss. Clin J Am Soc Nephrol 5(10):1867–1872

    Article  Google Scholar 

  13. Magnetti M, Leonardi G, Guarena C, Dolla C, Tarragoni R, Abbasciano I et al (2021) Hemodialysis arteriovenous fistula ligation after renal transplantation: Impact on graft resistive index. J Vasc Access 22(1):129–134

    Article  Google Scholar 

  14. Manca O, Pisano GL, Carta P, Manca EM, Piredda GB, Pili G et al (2005) The management of hemodialysis arteriovenous fistulas in well functioning renal transplanted patients: many doubts, few certainties. J Vasc Access 6(4):182–186

    Article  CAS  Google Scholar 

  15. Naesens M, Heylen L, Lerut E, Claes K, De Wever L, Claus F et al (2013) Intrarenal resistive index after renal transplantation. N Engl J Med 369(19):1797–1806

    Article  CAS  Google Scholar 

  16. Paoletti E, Bellino D, Signori A, Pieracci L, Marsano L, Russo R et al (2016) Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study. Nephrol Dial Transplant 31(7):1168–1174

    Article  CAS  Google Scholar 

  17. Patard JJ, Bensalah K, Lucas A, Rodriguez A, Manunta A, Rivalan J et al (2002) Management of vascular access for hemodialysis after successful kidney transplantation. Scand J Urol Nephrol 36(5):373–376

    Article  Google Scholar 

  18. Perl J, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y et al (2011) Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 22(6):1113–1121

    Article  Google Scholar 

  19. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG (2004) Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 15(2):477–486

    Article  Google Scholar 

  20. Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D et al (2019) Effects of arteriovenous fistula ligation on cardiac structure and function in kidney transplant recipients. Circulation 139(25):2809–2818

    Article  CAS  Google Scholar 

  21. Reddy YNV, Obokata M, Dean PG, Melenovsky V, Nath KA, Borlaug BA (2017) Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. Eur Heart J 38(24):1913–1923

    Article  Google Scholar 

  22. Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL (2016) Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet 388(10041):294–306

    Article  Google Scholar 

  23. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP et al (2018) Editor’s choice—vascular access: 2018 clinical practice guidelines of the European Ssociety for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55(6):757–818

    Article  Google Scholar 

  24. Soleimani MJ, Shahrokh H, Shadpour P, Shirani M, Arasteh S (2012) Impact of dialysis access fistula on cardiac function after kidney transplantation. Iran J Kidney Dis 6(3):198–202

    PubMed  Google Scholar 

  25. Tsao CW, Gona PN, Salton CJ, Chuang ML, Levy D, Manning WJ et al (2015) Left ventricular structure and risk of cardiovascular events: a Framingham heart study cardiac magnetic resonance study. J Am Heart Assoc 4(9):e2188

    Article  Google Scholar 

  26. Walther CP, Nambi V, Hanania NA, Navaneethan SD (2020) Diagnosis and management of pulmonary hypertension in patients with CKD. Am J Kidney Dis 75(6):935–945

    Article  Google Scholar 

  27. Weekers L, Vanderweckene P, Pottel H, Castanares-Zapatero D, Bonvoisin C, Hamoir E et al (2017) The closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline. Nephrol Dial Transplant 32(1):196–200

    PubMed  Google Scholar 

  28. Wheeler DC, Steiger J (2000) Evolution and etiology of cardiovascular diseases in renal transplant recipients. Transplantation 70(11 Suppl):S41–S45

    Google Scholar 

  29. Wilmink T, Hollingworth L, Dasgupta I (2016) Access ligation in transplant patients. J Vasc Access 17(Suppl 1):S64–S68

    Article  Google Scholar 

  30. Zanow J, Petzold K, Petzold M, Krueger U, Scholz H (2006) Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring. J Vasc Surg 44(6):1273–1278

    Article  Google Scholar 

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Authors and Affiliations

  1. Univ.-Klinik für Gefäßchirurgie, Universitätsklinik Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    Maria Gummerer, Josef Klocker & Sabine Wipper

  2. Univ.-Klinik für Innere Medizin IV, Universitätsklinik Innsbruck, Innsbruck, Österreich

    Martin Tiefenthaler

  3. Univ.-Klinik für Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinik Innsbruck, Innsbruck, Österreich

    Christian Margreiter

Authors
  1. Maria Gummerer
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  2. Martin Tiefenthaler
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  3. Christian Margreiter
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  4. Josef Klocker
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  5. Sabine Wipper
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Corresponding author

Correspondence to Maria Gummerer.

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Interessenkonflikt

M. Gummerer, M. Tiefenthaler, C. Margreiter, J. Klocker und S. Wipper geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gummerer, M., Tiefenthaler, M., Margreiter, C. et al. Shuntligatur nach Nierentransplantation: Pro und Kontra. Gefässchirurgie 26, 530–535 (2021). https://doi.org/10.1007/s00772-021-00826-5

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  • DOI: https://doi.org/10.1007/s00772-021-00826-5

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