Vajdič B, Arnol M, Ponikvar R, Kandus A, Buturović-Ponikvar J
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Transplant Proc. 2010 Dec;42(10):4006-9. doi: 10.1016/j.transproceed.2010.09.057.
There is no accepted policy for preserving or ligating arteriovenous fistula (AVF) after successful kidney transplantation. The aim of this study was to compare kidney graft function and survival between patients with a functional AVF at 1 year after-transplantation with those having a nonfunctional AVF. This historical cohort study included 311 kidney transplant recipients between January 2000 and December 2008 with a functional AVF at the time of transplantation. Patients were divided into 2 groups according to functional status of AVF at 1 year after transplantation. Graft function was assessed at 1 year by serum creatinine and estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease formula. Kaplan-Meier and Cox proportional hazards analyses were used to assess the relationship between the functional status of the AVF and graft survival. The 311 recipients had a mean age of 47 ± 11 years (range, 14 to 70) with 188 (60.5%) males. Patients with functional AVF at 1 year (n = 239) showed higher serum creatinine and lower eGFR values than those with nonfunctional AVF (n = 72): namely 110 ± 38 μmol/L and 69 ± 21 mL/min/1.73 m(2) versus 99 ± 30 μmol/L and 74 ± 19 mL/min/1.73 m(2), respectively (P < .05). Persistence of a functional AVF at 1 year after transplantation was associated with a greater incidence of eGFR <60 mL/min/1.73 m(2) compared with nonfunctional AVF: 36.8% versus 23.6% (odds ratio, 1.885; 95% confidence interval [CI], 1.031-3.450; P = .038). The 5-year allograft survival rates were 60% among patients with a functional AVF versus 75% among those with a nonfunctional AVF (P = .045). The adjusted analyses revealed the persistence of a functional AVF to be associated with an increased risk for future allograft loss (hazard ratio, 1.336; 95% CI, 1.018-1.755; P = .037). In conclusion, the persistence of a functional AVF was associated with a lower eGFR at 1 year after-transplantation and an increased risk for future allograft loss.
肾移植成功后，目前尚无公认的保留或结扎动静脉瘘（AVF）的策略。本研究旨在比较移植后1年时具有功能性AVF的患者与具有非功能性AVF的患者之间的肾移植功能及生存率。这项历史性队列研究纳入了2000年1月至2008年12月期间311例移植时具有功能性AVF的肾移植受者。根据移植后1年时AVF的功能状态将患者分为2组。使用肾病饮食改良公式的4变量法，通过血清肌酐和估计肾小球滤过率（eGFR）在1年时评估移植肾功能。采用Kaplan-Meier法和Cox比例风险分析法评估AVF功能状态与移植肾存活之间的关系。311例受者的平均年龄为47±11岁（范围14至70岁），其中男性188例（60.5%）。移植后1年时具有功能性AVF的患者（n = 239）血清肌酐水平较高，eGFR值较低，与具有非功能性AVF的患者（n = 72）相比：分别为110±38μmol/L和69±21 mL/min/1.73 m²，而后者为99±30μmol/L和74±19 mL/min/1.73 m²（P <.05）。与非功能性AVF相比，移植后1年时功能性AVF持续存在与eGFR<60 mL/min/1.73 m²的发生率更高相关：分别为36.8%和23.6%（优势比，1.885；95%置信区间[CI]，1.031 - 3.450；P =.038）。具有功能性AVF的患者5年移植肾存活率为60%，而具有非功能性AVF的患者为75%（P =.045）。校正分析显示功能性AVF持续存在与未来移植肾丢失风险增加相关（风险比，1.336；95% CI，1.018 - 1.755；P =.037）。总之，功能性AVF持续存在与移植后1年时较低的eGFR以及未来移植肾丢失风险增加相关。
