POSSIBILITIES OF USING ALLOGENEIC VASCULAR GRAFT AS LONG-TERM VASCULAR ACCESS FOR HEMODIALYSIS TREATMENT

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-1310, Poster Board= FRI-389

Introduction:

The problem of vascular access for hemodialysis remains an important issue of modern nephrology. Since 2021, our center has been practicing the use of allogeneic vascular grafts (allografts) as long-term vascular access in patients receiving hemodialysis, in whom the possibilities of forming native arteriovenous fistula have already been exhausted. The purpose of this study was to analyse the results of using allografts as long-term vascular access in patients receiving hemodialysis treatment.

Methods:

During the study, we retrospectively analyzed the results of clinical and laboratory examinations of 30 patients. An arteriovenous fistula in this cohort of patients was formed using an allograft between August 2021 and August 2024. 93.3% (n=28) of patients had a previous native arteriovenous fistula. The mean age of the patients was 52.1±13.6 years, 66.7% (n=20) were female and 33.3% (n=10) were male. One month after formation, we divided patients into two groups. The first group consisted of 63.3% (n=19) of patients, in whom the allograft was still functioning. The comparison group consisted of 36.7% (n=11) of individuals who experienced thrombosis of the allograft. The study groups were comparable in gender and age.

Results:

The survival of allografts was studied using the Kaplan-Meier method and is shown in the figure. 

Figure 1. Survival function of formed allografts

Analysis of the results of the preoperative examination in the study groups allowed to establish that the hemoglobin concentration in the blood of patients with a functioning allograft after one month was higher than that of patients with an allograft that thrombosed within one month: 101.1±16.1 g/l vs. 87.3±11.7 g/l, p<0.05. Preoperative C-reactive protein (CRP) level in patients of the main group was 7.6 (4.3-22) mg/l, which was lower than that of the comparison group patients - 20 (7.7-66.5) mg/l, p<0.05. The levels of calcium, phosphorus, total cholesterol, fibrinogen, as well as activated partial thromboplastin time (APTT) and international normalized ratio (INR), were comparable in the study groups, which is reflected in the table.

Parameters

Patients with functioning allograft, n=19

Patients with thrombosed allograft, n=11

Hemoglobin, g/l

101,1±16,1

87,3±11,7*

CRP, mg/l

7,6 (4,3-22)

20 (7,7-66,5)*

Total cholesterol, μmol/l

4,6±0,75

4,9±0,95

Total calcium, mmol/l

2,19 (2,03-2,38)

2,31 (2,0-2,44)

Phosphorus, mmol/l

1,92 (1,38-2,2)

1,93 (1,7-2,2)

Fibrinogen, g/l

3,91(3,44-5,0)

4,18(3,9-5,51)

ACTV, s

1,08 (0,98-1,15)

0,97 (0,9-1,1)

INR

0,96±0,09

1,0±0,09

Note - *- reliability of the difference of indicators in comparison with the group of patients with functioning allograft p<0.05.

Conclusions:

Thus, it was established that the formation of arteriovenous fistula using allograft is an alternative option of long-term vascular access in patients with terminal stage of chronic kidney disease who have exhausted the possibilities to form native arteriovenous fistula. Our analysis revealed that low hemoglobin levels and the presence of inflammatory processes were risk factors for early allograft thrombosis, which requires further investigation.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.