Arteriovenous fistula after renal transplantation: utility, futility or threat?

Creation of an arteriovenous (AV) fistula for haemodialysis therapy provides convenient access to the circulation in patients with end-stage renal disease. However, the chronic volume overload induced by the AV fistula induces structural and functional cardiac changes, including left ventricular remodelling, which may be deleterious. The balance between the need for vascular access and the deleterious effects of a patent AV fistula on cardiac function and morphology obviously favours the former in patients requiring long-term haemodialysis. After renal transplantation, however, the value of keeping an AV fistula patent is more uncertain and whether it should be closed after successful renal transplantation remains a matter of debate. Since recent studies have provided more insight into the cardiac and haemodynamic changes induced by the procedure, this review aims to summarize the pros and cons of AV fistula closure.