Purpose; After successful kidney transplantation (KT), arteriovenous access (AVA) is neither used nor useful. There are many debates whether to preserve an AVA or to perform a systematic access closure. But there is few data concerning the fate of AVA after KT. The purpose of this study is to determine the natural history of AVA after successful KT, and to identify the risk factor of spontaneous access closure in KT recipients. Methods; We performed a retrospective review of patients undergoing KT from June 2010 to July 2012. Among them, 115 patients with a functioning AVA on operation day were included. AVA patency was checked and recorded daily in admission and every visit of outpatient clinic since June 2010. These patients were divided into two groups according to patency of access and assessed contributing factor of spontaneous closure of AVA in KT recipients. 90 out of 115 patients underwent duplex ultrasonography to evaluate AVA flow just before or after KT. Results; Mean patients age was 46.8±9.3 years. There were 71 male. Mean duration from AVA construction to KT was 1937± 864 days and mean follow-up after KT was 385±25 day. The majority of patients (85.2%) had a native AVA and 80 patients (69.6%) had an AVA at wrist. At the end of follow-up, eighteen (15.7%) AVAs were spontaneously closed. Mean time to closure was 119±163 days, and 12 out of 18 were closed within 90 days after KT. AVA was spontaneously closed in 8.5% of male patients and 27.3% of female patients (P=.007), 12.2 % of native AVA and 35.3% of artificial AVA (P=.016), and 11.3% of wrist AVA and 25.7% of elbow AVA (P=.049). Spontaneously closed AVA tended to have lower mean access flow when compared functioning AVA (1094±841 ml/min versus 2085± 1656 ml/min, respectively, P=.019). On multivariate analysis, only female gender and AVA flow volume affected spontaneous AVA closure hazard ratio (HR): 8.240 (95% confidence interval [CI], 1.919-35.383) and 0.998 (95% CI, 0.997-0.999), respectively. ConclusionsThis study suggests the surgical closure of an AVA in male patients or a high output AV access could reduce unnecessary waiting times requiring spontaneous closure in patients with a high risk of AVA complications including arterial steal syndrome, aneurysm rupture, and high output cardiac failure.

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