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The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation.

Authors
  • Isaak, Andrej1, 2
  • Madurska, Marta J1
  • Stevenson, Karen S1
  • Gürke, Lorenz2
  • Kingsmore, David B1, 3
  • 1 Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
  • 2 Department of Vascular and Endovascular Surgery, University Hospital, Basel, Switzerland. , (Switzerland)
  • 3 Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
Type
Published Article
Journal
Clinical Transplantation
Publisher
Wiley (Blackwell Publishing)
Publication Date
May 01, 2020
Volume
34
Issue
5
Identifiers
DOI: 10.1111/ctr.13846
PMID: 32096878
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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