Functional status of hemodialysis arteriovenous fistula in kidney transplant recipients as a predictor of allograft function and survival.

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.