Have a Heart: Tie It Off — Update on Recommendations Regarding Vascular Access Ligation After Successful Renal Transplant

Purpose of Review Arteriovenous fistulas (AVF) are invaluable for patients undergoing hemodialysis (HD), but for patients with a functioning kidney transplant (KT), the complications and negative physiologic effects potentially outweigh the benefit. Following successful KT, surveillance of complications of HD access is limited and the true incidence is unknown. Recent Findings Multiple authors have demonstrated that fistula ligation results in decreased left ventricular mass and cardiac output without increased creatinine. Additional literature has shown improvement of symptoms of right heart failure. Current research is investigating the impact of AVF on quality of life and whether fistula flow predicts which patients will benefit from ligation. Summary Improved understanding of the cardiovascular effects of AVFs, and of which patients are at highest risk, will allow providers to make educated judgements about when to consider ligation. Assessment tools may provide valuable insights into post-transplant ligation plans. Transplant centers have strong multidisciplinary teams and so are uniquely situated to guide this decision-making.