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Patients on maintenance hemodialysis (MHD) with a vascular catheter (VC) have inferior outcomes compared to patients with an arteriovenous fistula (AVF). To estimate the legacy effect of the VC, we investigate the effect of pre-transplant hemodialysis vascular access on early post-renal transplant (Tx) outcomes.
Single center prospective observational study involving live-related renal Tx recipients from Jan 2019 to Dec 2022; with pre-Tx MHD vintage of >2weeks and minimum 6-month post-Tx follow-up, were included. Study was approved by Institutional Ethics Committee (IEC1-293). Patients were grouped to either being on VC or AVF, as per dialysis access in the immediate pre-Tx month. Demography, biochemistry, pre- and post-Tx clinical events were compared between the groups. Data was expressed as mean±S.D., median (IQR) and frequencies (percentages). Student T test, Mann-Whitney and Chi-square test was applied to analyse parametric, non-parametric and categorical variables respectively. To investigate impact of vascular access on clinical outcomes, logistic regression was used, and results expressed as odds ratios (ORs). Significant variables (P value <0.20) on univariate analysis were included for multivariate model. Data entry and analysis was performed using SPSS version 29. Results were considered statistically significant if P <0.05.
Among 50 recipients included for analysis, 46 (92%) were males. One-third, 16(32%) were dialyzed by VC, and 10/16 by temporary catheter, at the time of renal Tx. The primary motivation for MHD patients on VC was to forego AVF surgery in favor of an early kidney transplant. Patients on VC had a shorter dialysis vintage (4 v/s 9 months; P=0.016), had higher incidence of non-elective (P=0.007) and infection-related (P=0.001) admissions in the preceding six months, prior to Tx and a higher day-30 serum creatinine (1.30±0.60 v/s 1.23±0.34; P=0.033) post-Tx. None of the other factors were significant between the two groups (Table 1). On logistic regression, recipient age, pre-Tx hemoglobin, non-elective and infection-related admissions were the significant factors. On multi-variate model none of the variables were significant between the two groups.
MHD patients on VC, had a higher non-elective and infection-related admissions prior to renal Tx and a higher day-30 post-Tx serum creatinine. Despite a stormy pre-transplant course in patients on VC, six-month post-transplant clinical outcomes are comparable to recipients with an AVF.