*Purpose: Ligation of AVF post kidney transplant often done mostly for esthetic reasons, however, they are occasionally indicated in the presence severe steal syndrome, severe heart failure or pulmonary hypertension. Several observational studies have shown conflicting outcome with respect to the clinical implication of post kidney transplant AV-Fistula ligation on hemodynamics and allograft function. A few observational studies have shown worse outcome with increased risk for accelerated kidney allograft decline with no remarkable effect on blood pressure profile post AVF ligation. We conducted an observational study in our academic center to see the effects of AVF ligation on Hypertension and kidney function parameters at one-year post procedure.

*Methods: This was an observational case series with retrospective chart review of patients who underwent AVF ligation between January 1 2015 and September 30 2019 with a minimal of one year follow up. Patient with baseline history of kidney allograft rejection, donor specific antibodies (DSA) or with rising serum creatinine leading to the AVF ligation were excluded from the study. Blood pressure profile including the number of anti-hypertensive medications in use, serum creatinine and Urine protein creatine ratio were compared at 12 months before and after procedure.

*Results: Sixty-four patients were included in the study. There was no clinically significant difference in Mean Serum Creatinine and Mean Urine Protein-Creatinine ratio at 12 months before and 12 months after AVF ligation. However, there was a modest increase in the mean MAP from 93 mmhg at 12 months before AVF ligation to 99 mmhg at 12 months after procedure (Delta positive change of 6 mmhg).

*Conclusions: Post-kidney transplant AV fistula Ligation appears to have no significant effect on kidney allograft function one-year post procedure though it may be associated with higher blood pressure.

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