Effect of closure of the arteriovenous fistula on left ventricular dimensions in renal transplant patients

BACKGROUND: Left ventricular hypertrophy is common in renal transplant patients. One of the factors that might contribute to this phenomenon is the persisting presence of an arteriovenous (AV) fistula. Several reports have described the presence of high-output cardiac failure, which subsided after closure of the AV fistula. However, the long-term effects of elective closure of the AV fistula on left ventricular dimensions in stable renal transplant patients have never been prospectively studied. SUBJECTS AND METHODS: Twenty patients (15 male, 5 female; mean age 51+/-12 years) with a well-functioning renal transplant were included. Patients with severe heart failure (NYHA III or IV) were excluded. Before and 3-4 months after closure of the AV fistula, an echocardiogram was performed. Fistula flow was assessed by colour duplex-Doppler sonography. RESULTS: Mean fistula flow was 1790+/-648 ml/min. After closure of the fistula, left ventricular end-diastolic diameter (LVEDD) (51.5+/-5.8 vs 49.3+/-5.4 mm, P<0.01) and left ventricular mass index (LVMi) (135.0+/-34.1 vs 119.8+/-23.2) decreased. The change in LVMi after fistula closing was significantly related to the LVMi and LVEDD before operation (r=0.74 and r=0.60, P<0.01), but not to fistula flow. Interventricular septal and posterior-wall diastolic thickness did not change. Heart rate decreased (72+/-10 vs 69+/-9, P:=0.03) Blood pressure and creatinine clearance did not change. CONCLUSION: Closure of the arteriovenous fistula in stable renal transplant patients results in a decrease in LVMi, due to a reduction in LVEDD. The change in LVMi is significantly related to the LVMi and LVEDD before fistula closing. In patients with a well-functioning allograft and persistent LV dilatation, closure of the AV fistula might be considered.