Clinical outcome of hemodialysis access in liver transplanted patients

Abstract

Clinical outcomes of hemodialysis access among liver transplant recipients

Abstract Background End-stage renal disease (ESRD) is common following liver transplantation (LT). However, there is a scarcity of evidence to guide the selection of vascular access in LT patients who develop ESRD. This study aimed to compare the clinical outcomes of arteriovenous fistula (AVF) and arteriovenous graft (AVG) in LT and non-LT patients with ESRD. Methods This study included 126 patients who underwent LT and required hemodialysis access creation between January 2006 and December 2021 (103 AVF and 23 AVG). The outcomes under study were rates of primary failure, complication rates, and primary and secondary patency among LT-ESRD patients. We compared outcomes of each LT-ESRD patient matched with two non-LT ESRD patients based on a basic characteristic score. Results Out of 126 LT-ESRD patients, 103 (81%) received LT-AVF, and 23 (19%) received LT-AVG. The LT-AVG group had higher primary failure rates, as well as higher rates of thrombotic occlusion and infection, compared to the LT-AVF group (p=0.003, 0.001, and 0.032, respectively). Both primary and secondary patency rates were significantly higher in the LT-AVF group (p=0.040 and 0.009, respectively). No significant differences in clinical outcomes were observed between the LT and matched non-LT groups. Univariate and multivariate analyses indicated that AVG was associated with lower primary and secondary patency rates in all four groups (HR, 2.43; 95% CI, 1.61-3.68; p<0.001). Conclusion In LT-ESRD patients, AVF demonstrated superior outcomes compared with AVG. There were no significant differences in the clinical outcomes of AVF and AVG between LT and non-LT patients. This study suggested the superiority of AVF over AVG in LT patients, mirroring findings in general ESRD patients.

Keywords: end-stage renal disease, liver transplantation, outcome, vascular access