Arteriovenous fistula ligation promotes positive cardiac remodeling after kidney transplant

CHICAGO — Among patients who had a kidney transplant, ligation of the arteriovenous fistula resulted in decreased left ventricular mass and reduction in volume of all four cardiac changers, researchers reported at the American Heart Association Scientific Sessions.

Arteriovenous fistula ligation also conferred reductions in N-terminal pro-B-type natriuretic peptide levels.

CVD is responsible for 40% of deaths among kidney transplant recipients, and LV mass is strongly associated with CVD and CV mortality, so reducing LV mass in this population is important, Michael B. Stokes, MBBS, FRACP, from the department of cardiology at Royal Adelaide Hospital, Australia, said during a presentation.

“Arteriovenous fistulas contribute adversely to cardiac remodeling and function,” he said. “There is no guideline consensus on management of a redundant arteriovenous fistula following successful kidney transplantation. No previous randomized controlled trials have been performed that study the cardiovascular effects of ligation of arteriovenous fistulas following successful kidney transplantation.”

Stokes and colleagues randomly assigned 64 patients who had a successful kidney transplant at least 1 year prior, stable kidney function and a persistent and functioning arteriovenous fistula to arteriovenous fistula ligation (mean age, 59 years; 63% men) or no intervention (mean age, 60 years; 71% men). All patients underwent cardiac MRI at baseline and 6 months.

The primary endpoint of change in LV mass at 6 months was significant in the ligation group (decrease, 22.1 g; 95% CI, –29.1 to –15) but not in the control group (increase, 1.2 g; 95% CI, –4.8 to 7.2), Stokes said.

The ligation group also had significant 6-month declines in LV end diastolic volume, LV end systolic volume, left atrial area, right ventricular end diastolic volume, RV end systolic volume and right atrial area (P < .01 for all), whereas the control group did not, he said.

NT-proBNP levels were reduced in the ligation group at 6 months (from 411 ng/L to 166 ng/L; P < .01), but not in the control group, according to the researchers.

The ligation group also had a reduction in left atrial volume (P < .001) and a trend toward reduction in pulmonary artery peak velocity (P = .07), whereas the control group did not, Stokes said.

Change in estimated glomerular filtration rate at 6 months did not differ between the groups, Stokes and colleagues found.

In the ligation group, six patients had thrombosis, which was resolved with rest and anti-inflammatory therapy, two patients had infections, which were resolved with antimicrobial therapy, and no patients needed readmission or surgical reintervention, Stokes said.

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“Control patients face persisting and substantial deleterious cardiac remodeling,” he said. “Further investigation would clarify the impact of [arteriovenous] fistula ligation on clinical outcomes following kidney transplantation.” – by Erik Swain

Reference:

Stokes MB, et al. LBS.05 - Late Breaking Clinical Trial: Hot News in HF. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.

Disclosure: Stokes reports no relevant financial disclosures.