Arteriovenous Fistula Nonmaturation: What's the Immune System Got to Do with It?. Issue 11 (25th November 2021) - Farrington, Crystal A.
Visual Abstract: Abstract : Key Points: Arteriovenous fistula (AVF) nonmaturation is a persistent problem, and there are some notable disparities in AVF maturation outcomes by sex and race. Panel reactive antibodies (PRA) are markers of immune system reactivity that tend to be higher among female and Black patients, and are associated with greater cardiovascular mortality outside the transplant setting. On multivariable analysis, class II PRA were independently associated with greater rates of AVF nonmaturation in this study population, suggesting a possible role for the adaptive immune system in AVF maturation outcomes. Background: Arteriovenous fistula (AVF) nonmaturation is a persistent problem, particularly among female and Black patients. Increasingly, the immune system has been recognized as an important contributor to vascular disease, but few studies have examined immune factors relative to AVF maturation outcomes. This study evaluated the association of serum panel reactive antibodies (PRA), a measure of immune system reactivity assessed in patients undergoing kidney transplant evaluation, with AVF nonmaturation. Methods: We identified 132 patients at our institution who underwent surgical AVF placement between 2010–2019 and had PRA testing within 1 year of AVF creation. Multivariable logistic regression was used to determine the association of patient demographic and clinical factors, class I and class II PRA levels, and preoperative arterial and venous diameters with AVF maturation outcomes. Results: AVF nonmaturation was more likely in females than males (44% versus 20%, P =0.003) and in Black than white patients (40% versus 13%, P =0.001). Class II PRA was higher in females than males (12%±23% versus 4%±13%, P =0.02). In the multivariable model, AVF nonmaturation was associated with class II PRA (adjusted odds ratio [aOR], 1.34 per 10% increase; 95% confidence interval [95% CI], 1.04 to 1.82, P =0.02) and Black race (aOR, 3.34; 95% CI, 1.02 to 10.89, P =0.03), but not with patient sex or preoperative arterial or venous diameters. Conclusions: The association of elevated class II PRA with AVF nonmaturation suggests the immune system may play a role in AVF maturation outcomes, especially among female patients.