Prédictions of autogenous arteriovenous hemodialysis access thrombosis after renal transplantation
2017
Ben Ahmed, Sabrina | Hadj-Abdelkader, Mohamed | Benezit, Marie | Deteix, Patrice | Heng, Anne-Elisabeth | Rosset, Eugenio | Service Chirurgie Cardio-Vasculaire [CHU Clermont-Ferrand] ; CHU Gabriel Montpied [Clermont-Ferrand] ; CHU Clermont-Ferrand-CHU Clermont-Ferrand-Pôle Médico-Chirurgical des pathologies Cardio-Vasculaires ; CHU Gabriel Montpied [Clermont-Ferrand] ; CHU Clermont-Ferrand-CHU Clermont-Ferrand | Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE) ; Centre Ingénierie et Santé (CIS-ENSMSE) ; École des Mines de Saint-Étienne (Mines Saint-Étienne MSE) ; Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE) ; Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Service Néphrologie, Hémodialyses [CHU Clermont-Ferrand] ; Pôle RHEUNNIRS [CHU Clermont-Ferrand] ; CHU Gabriel Montpied [Clermont-Ferrand] ; CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand] ; CHU Clermont-Ferrand-CHU Clermont-Ferrand | Unité de Nutrition Humaine (UNH) ; Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]) | Faculté de Médecine ; Université d'Auvergne - Clermont-Ferrand I (UdA)
We conducted a monocentric retrospective review of prospective clinical records of 145 patients with a functional aAVF who had a RT between January 2004 and December 2009 in the University Hospital of Clermont-Ferrand. Our primary endpoint was the thrombosis of the aAVF. Univariate and multiple logistic regression analyses were used to identify risk factors associated to aAVF thrombosis after RT.ResultsThere 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 (0.03-123) and from aAVF creation 97 months (5-262). 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 (respectively, P=0.03 and P=0.02) and multiple logistic regression analyses (respectively, P=0.03 and P=0.047).ConclusionsThrombosis 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.
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