The Management of Lower Limb Arteriovenous Grafts in the Peri-Operative Period Following Renal Transplantation.

BACKGROUND: The presence of a lower limb arteriovenous graft (LL-AVG) is indicative of a group of complex haemodialysis patients who have precarious long-term vascular access. The aim of this study is to describe our experience of the clinical decisions and interactions between LL-AVG and renal transplantation.

METHODS: The records of 23 patients who received a transplant in the presence of a LL-AVG between 2010 and 2018 were analysed: firstly, to determine if patients with a LL-AVG received extended criteria transplants, the implantation procedure, and the management of the LL-AVG in the post-operative period.

RESULTS: Seventeen patients (74%) had 'end-stage access' and were thus considered for all offer stratified by the kidney donor profile index (KDPI) and donor type (DBD or DCD). In eleven patients (48%) a kidney with a high risk of delayed graft function was transplanted. Same-sided renal transplantation occurred in only 35% of cases, and of these only one LL-AVG was ligated immediately to improve transplant perfusion.

CONCLUSION: A patient-based approach applied in decision-making on management of the LL-AVG post-transplantation should include 1. the likelihood of delayed graft function, 2. the need for post-operative haemodialysis, 3. the side of proposed transplant compared to the LL-AVG, 4. local complications.