The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation. Issue 5 (6th April 2020)

• Record Type: Journal Article
• Authors: Isaak, Andrej; Madurska, Marta J.; Stevenson, Karen S.; Gürke, Lorenz; Kingsmore, David B.
• Is Part Of: Clinical transplantation. Volume 34:Issue 5(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-04-06
• Subjects: clinical decision‐making -- delayed graft function -- expanded criteria donor -- lower limb arteriovenous grafts; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.13846
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: The presence of a lower limb arteriovenous graft (LL‐AVG) is indicative of a group of complex hemodialysis patients who have precarious long‐term vascular access. The aim of this study is to describe our experience of the clinical decisions and interactions between LL‐AVG and renal transplantation. Methods: The records of 23 patients who received a transplant in the presence of a LL‐AVG between 2010 and 2018 were analyzed: firstly, to determine whether patients with a LL‐AVG received extended criteria transplants, the implantation procedure, and the management of the LL‐AVG in the post‐operative period. Results: Seventeen patients (74%) had "end‐stage access" and were thus considered for all offer stratified by the kidney donor profile index (KDPI) and donor type (DBD or DCD). In eleven patients (48%), a kidney with a high risk of delayed graft function was transplanted. Same‐sided renal transplantation occurred in only 35% of cases, and of these, only one LL‐AVG was ligated immediately to improve transplant perfusion. Conclusion: A patient‐based approach applied in decision‐making on management of the LL‐AVG post‐transplantation should include (a) the likelihood of delayed graft function, (b) the need for post‐operative hemodialysis, (c) the side of proposed transplant compared to the LL‐AVG, and (d) local complications.