To Ligate or Not to Ligate: A Meta-analysis of Cardiac Effects and Allograft Function following Arteriovenous Fistula Closure in Renal Transplant Recipients

Background: There are no available guidelines regarding preserving or ligating an arteriovenous fistula following successful kidney transplantation. Therefore, we performed a meta-analysis to formulate a clear opinion regarding the status of arteriovenous fistula in renal allograft recipients. Methods: We performed an electronic literature search of PubMed, EMBASE, and the Cochrane Library for eligible studies up to January 2019. We aimed to systematically evaluate cardiac systolic and diastolic function and allograft function after arteriovenous fistula closure. The primary outcome was the differences in left ventricular mass index, left ventricular end-diastolic diameter, ejection fraction, and serum creatinine levels between patients with occluded arteriovenous fistula versus patent arteriovenous fistula. Results: Renal transplant recipients with occluded arteriovenous fistula had lower left ventricular mass index values and left ventricular end-diastolic diameter compared with those with patent arteriovenous fistula. The pooled mean differences were 21.67 (95% confidence interval [CI] 19.94 to 23.39, P < 0.001) and 2.75 (95% CI 1.47 to 4.04, P < 0.001), respectively. Patients with occluded arteriovenous fistula also had lower serum creatinine levels versus those with patent arteriovenous fistula. The pooled mean difference was 0.10 (95% CI 0.04 to 0.17, P = 0.003). We saw no difference regarding ejection fraction between the groups. The pooled mean difference was 0.84 (95% CI -0.85 to 2.53, P = 0.33). Conclusions: Our meta-analysis demonstrated that arteriovenous fistula closure improves cardiac morphology and has better kidney graft function. Arteriovenous fistula closure may be considered in patients with a well-functioning allograft.