Rezende, Vitor

Arteriovenous fistulas (AVFs) are the preferred method for establishing long-term vascular access in patients undergoing hemodialysis; however, high-flow AVFs may increase cardiovascular strain after kidney transplantation, often necessitating fistula closure. Currently, no established guideline exists for managing high-flow fistulas in post-transplant patients with stable kidney function, and available studies report heterogeneous results with small sample sizes and different methodologies. We performed a systematic search of PubMed, Cochrane, and Embase up to December 2024 for observational studies and randomized controlled trials comparing AVF ligation versus maintenance in patients with end-stage kidney disease. The meta-analysis was conducted using Cochrane’s RevMan software using mean difference (MD) and 95% confidence interval. Twelve studies including 844 patients were analyzed, of whom 409 (48%) underwent AVF ligation, with follow-up ranging from 3 to 62.5 months. AVF ligation was associated with a significant reduction in left ventricular mass index (MD −10.92 g/m 2 ; 95% confidence interval −17.84 to −3.99; p = 0.007) and cardiac index (MD −0.56 L/min/m 2 ; 95% confidence interval −1.05 to −0.07; p = 0.03), indicating attenuation of the hyperdynamic circulatory state related to a persistent AVF. No significant differences were observed in left ventricular ejection fraction or blood pressure parameters. Serum creatinine levels were modestly reduced following AVF ligation (MD −0.12 mg/dL; 95% confidence interval −0.22 to −0.03; p = 0.02), while estimated glomerular filtration rate remained unchanged. Overall, AVF ligation was associated with favorable cardiac remodeling reflected by reductions in left ventricular mass and cardiac output, with supportive changes in secondary echocardiographic parameters and no apparent deterioration in renal function.