Natural history of arteriovenous shunts for haemodialysis after renal transplantation.

Introduction: The objective of this study was to assess the longterm outcom e of AV shunts in renal transplant recipients, to discuss mechanisms affect ing their functioning and the surgical strategy designed to optimally prese rve the venous capital in the hypothesis of a return to dialysis. Material and Methods: 160 renal transplant recipients, with a mean age of 4 7 years,were reviewed. AV shunts were performed at the wrist in 95% of case s and in the cubital fossa in 13% of cases. The AV shunt had been performed an average of 29 months before renal transplantation. Results: 62% of AV shunts were considered to be functional with a mean foll ow-up of 69 months after transplantation and 95 months after creation. The intraoperative and early and late postoperative thrombosis rates were 6%, 7 .5% and 17%, respectively. The AV shunt was subsequently closed in 12 patie nts (7.5%). Conclusion: Native distal AV shunts, although not used after renal transpla ntation, have a prolonged survival . The main risk is thrombosis which can be prevented intraoperative and perioperatively. These results encourage a conservative attitude to all well tolerated AV shunts.