| 김 산¹, 문정윤¹, 허정은¹, 안정명¹, 이현국¹, 조경임¹, 김태익¹, 이진호², 이동렬², 공진민² |
Background: Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients. Enhenced cardiac load by the persistence of functioning AVF in posttransplant period is associated with LV hypertrophy and may adversely influence cardiac outcome. Methods: To investigate the impact of AVF on LV mass and function in kidney transplant recipients, 46 patients with functioning AVF were randomly assigned to surgical closure of AVF (FC group, n=23) or maintenance of fistula (FM group, n=23). Twenty-five additional patients with no functioning AVF, matched for age, sex and posttransplant months were selected for no fistula control (NF group). Serum creatinine of all participants was stable(1.2±0.2 mg/dl). Mean age was 42±11 years. Mean posttransplant month was 78±53(12-161). Transthoracic echocardiographic measurement and determination of N-terminal pro-BNP, CRP, and cTnT were done at 0, 1 and 6 months in FC group , and 0 and 6 months in FM and NF group. Two patients of FC group did not agree to close the fistula and only baseline data of these patients was analyzed. In two patients of FM group, fistula was spontaneously closed during study period. Results: Baseline LV mass index(LVMI) was larger in patients with functioning AVF (FC and FM) compared with NF (133.0±24.5 gram vs 120.7±19.6, respectively, p=0.027). Baseline echocardiographic indices of systolic and diastolic LV function such as LVEF, E/A ratio, E/E' and Tei index were not different between groups. In patients of FC group, LVMI (134.8±31.4 to 130.3±31.6, p=0.014) significantly reduced at one month after closure, and no further significant change was observed at 6 months. No significant change in LV systolic and diastolic performance indices were observed. N-terminal pro-BNP, CRP and cTnT did not differ between groups in baseline value and did not change after closure. Conclusions: We conclude that the persistence of functioning AVF in renal transplant patients is associated with LVH, and which can be reduced by surgical closure of fistula. As LVH is one of major determinants of cardiovascular outcome in transplant patients, it would be prudent to consider closure of fistula in patients with stable graft function.
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