Long-Term Impact of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients: A 5-Year Follow-Up Observational Cohort Study

Tania Salehi, Nicholas J. Montarello, Nishant Juneja, Michael B. Stokes, Daniel J. Scherer, Kerry F. Williams, David King, Ewan Macaulay, Christine H. Russell, Santosh A. Olakkengil, Robert P. Carroll, Randall J. Faull, Karen S.L. Teo, Stephen P. McDonald, Matthew I. Worthley, Patrick T. Coates, Nitesh N. Rao

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Abstract Background The long-term effects of arteriovenous fistula (AVF) ligation on cardiovascular structure following kidney transplantation remain uncertain. A prospective randomized, controlled trial (RCT) examined the effect of AVF ligation at 6 months on cardiovascular magnetic resonance imaging (CMR)-derived parameters in 27 kidney transplant recipients compared with 27 controls. A mean decrease in left ventricular mass (LVM) of 22.1 g (95% CI, 15.0 to 29.1) was observed compared with an increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). We conducted a long-term follow-up observational cohort study in the treated cohort to determine the evolution of CMR-derived parameters compared with those documented at 6 months post-AVF ligation. Methods We performed CMR at long-term follow-up in the AVF ligation observational cohort from our original RCT published in 2019. Results were compared with CMR at 6 months postintervention. The coprimary end point was the change in CMR-derived LVM and LVM index at long-term follow-up from imaging at 6 months postindex procedure. Results At a median of 5.1 years (interquartile range, 4.7-5.5 years), 17 patients in the AVF ligation group were studied with repeat CMR with a median duration to follow-up imaging of 5.1 years (IQR, 4.7-5.5 years). Statistically significant further reductions in LVM (-17.6±23.0 g, P=0.006) and LVM index (-10.0±13.0 g/m 2, P=0.006) were documented. Conclusions The benefit of AVF ligation on LVM and LVM index regression appears to persist long term. This has the potential to lead to a significant reduction in cardiovascular mortality.

Original languageEnglish
Pages (from-to)1141-1147
Number of pages7
Issue number7
Publication statusPublished or Issued - 1 Jul 2021


  • arteriovenous fistula
  • cardiac magnetic resonance imaging
  • heart ventricles
  • kidney transplantation
  • left ventricular mass
  • ligation
  • transplantation

ASJC Scopus subject areas

  • Nephrology
  • Medicine (miscellaneous)

Cite this