Ben Ahmed Sabrina, Hadj-Abdelkader Mohamed, Benezit Marie, Deteix Patrice, Heng Anne-Elisabeth, Rosset Eugenio
Service de Chirurgie Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France; INSERM U1059, SAINBIOSE, Saint-Etienne, France.
Service de Néphrologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Ann Vasc Surg. 2017 Jul;42:231-237. doi: 10.1016/j.avsg.2017.01.008. Epub 2017 Apr 4.
The fate of autogenous arteriovenous fistula (aAVF) after renal transplantation (RT) remains variable. The aim of this study was to determine the predictors for their thrombosis after RT.
We conducted a monocentric retrospective review of prospective clinical records of 145 patients with a functional aAVF who had an RT between January 2004 and December 2009 in the University Hospital of Clermont-Ferrand. Our primary end point was the thrombosis of the aAVF. Univariate and multiple logistic regression analyses were used to identify risk factors associated to aAVF thrombosis after RT.
There were 105 men (72%) and 40 women (28%), mean age 52 years (range: 18.4-74.7 years). The aAVF was created on average 40 months (range: 2-169) before the RT. The aAVF was distal in 96 cases (66%) and proximal in 49 cases (34%). Nineteen aAVF (13.1%) were complicated and required an endovascular or surgical repair before RT. Forty-nine patients (34%) required multiple aAVF (>2). Mean follow-up from RT was 58 months (range: 1 day-123 months) and from aAVF creation 97 months (range: 5-262 months). At the end of the follow-up, 81 aAVFs (59%) were patent, 42 (29%) were thrombosed, and 22 (15%) were surgically closed. Patients that had multiple fistulas before RT and active smokers were significantly at risk to thrombose their aAVF after the RT in univariate (P = 0.03 and P = 0.02, respectively) and multiple logistic regression analyses (P = 0.03 and P = 0.047, respectively).
Thrombosis is a part of the natural history of the aAVF after RT. A history of multiple aAVF creations before RT and active smoking were associated to significant increased risk for fistula thrombosis. Because hemodialysis may be needed after RT, the aAVF patency should be preserved, excepted when the aAVF resulted in complications. Follow-up of the aAVF after RT is important to detect and treat complications before thrombosis occurs.
肾移植（RT）后自体动静脉内瘘（aAVF）的转归仍存在差异。本研究旨在确定肾移植后其发生血栓形成的预测因素。
我们对2004年1月至2009年12月在克莱蒙费朗大学医院接受肾移植的145例具有功能性aAVF患者的前瞻性临床记录进行了单中心回顾性分析。我们的主要终点是aAVF的血栓形成。采用单因素和多因素logistic回归分析来确定肾移植后与aAVF血栓形成相关的危险因素。
有105名男性（72%）和40名女性（28%），平均年龄52岁（范围：18.4 - 74.7岁）。aAVF平均在肾移植前40个月（范围：2 - 169个月）建立。96例（66%）aAVF位于远端，49例（34%）位于近端。19例aAVF（13.1%）出现并发症，在肾移植前需要进行血管内或外科修复。49例患者（34%）需要建立多个aAVF（>2个）。肾移植后的平均随访时间为58个月（范围：1天 - 123个月），从aAVF建立开始的平均随访时间为97个月（范围：5 - 262个月）。随访结束时，81个aAVF（59%）通畅，42个（29%）发生血栓形成，22个（15%）通过手术关闭。在单因素（分别为P = 0.03和P = 0.02）和多因素logistic回归分析（分别为P = 0.03和P = 0.047）中，肾移植前有多个内瘘和现吸烟者在肾移植后其aAVF发生血栓形成的风险显著增加。
血栓形成是肾移植后aAVF自然病程的一部分。肾移植前有多次建立aAVF的病史和现吸烟与内瘘血栓形成风险显著增加相关。由于肾移植后可能需要进行血液透析，应保持aAVF通畅，除非aAVF导致并发症。肾移植后对aAVF进行随访对于在血栓形成前检测和治疗并发症很重要。
