*Purpose: Whether or not to ligate functioning arteriovenous fistula (AVF) after renal transplantation remains controversial. Recently, there have been several reports showing that the presence or the absence of AVF have significant impact on renal function of the patient. Through retrospective review, here we sought to explore the effect of AVF ligation on allograft function in renal transplant patients.

*Methods: Patients who underwent surgical closure of the arteriovenous fistula (AVF) after renal transplantation between January 2007 and December 2016 were retrospectively reviewed. We evaluated the clinical significance of AVF closure on allograft function by comparing the estimated glomerular filtration rate (eGFR) and graft survival of the AVF closure group and the propensity score matched controls (AVF non-closure group). Variables matched for the analysis was patient age, sex, year of transplant, multiple transplant, donor type (deceased / living), and number of antigen mismatch. We further examined whether AVF ligation affects the slope of eGFR change after transplantation. A generalized estimating equation with a compound symmetry covariance structure was used to estimate whether ligating the functioning fistula was associated with changes in eGFR levels. Time was balanced before versus after AVF closure, with at least 6 observations during the each time period.

*Results: A total of 155 patients had AVF closed at median 16.1 [interquartile range (IQR) 11.1-23.7] months after transplantation. When compared to propensity score matched AVF non-closure group (n=155), eGFR at 1, 3, and 5 year did not differ significantly (57.7 vs. 59.4, p=0.45; 58.2 vs. 61.5, p=0.26; 63.4 vs 62.4, p=0.90, respectively). Number of patients with acute rejection or graft failure also did not differ between the two groups. The eGFR of the AVF closure group showed increase in trend before the closure of the AVF, and seem to show decrease in trend after the closure (0.079 mL/min/1.73 m²/month vs. -0.031mL/min/1.73 m²/month), however the difference was statistically insignificant (p-value for slope change = 0.21).

*Conclusions: Fistula ligation in a stable renal allograft recipient does not negatively affect allograft function.

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