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Shuntligatur nach Nierentransplantation: Pro und Kontra

Arteriovenous fistula ligation after kidney transplantation: pros and cons

Zusammenfassung

Hintergrund

Ein arteriovenöser Shunt ist der „golden standard“ für den Gefäßzugang bei Patienten mit dialysepflichtiger Niereninsuffizienz. Nach einer erfolgreichen Nierentransplantation wird der Shunt jedoch nicht mehr benötigt. In diesem Artikel möchten wir die kardiovaskulären Vorteile und potenziellen Probleme einer routinemäßigen Shuntligatur nach einer Nierentransplantation erörtern.

Methoden

Es erfolgte eine narrative Literaturrecherche in der Literaturdatenbank von MEDLINE, PubMed und Cochrane Database of Systematic Reviews bis inklusive April 2021.

Ergebnisse und Diskussion

Eine Shuntligatur bei stabilen Nierentransplantatempfängern senkt den pulmonal arteriellen Druck und reduziert das Risiko eines Rechtsherzversagens und bringt damit ein geringeres kardiales Risiko mit sich. Die Entscheidung dazu sollte jedoch vorsichtig und patientenbezogen getroffen werden.

Abstract

Background

An arteriovenous fistula is the gold standard for vascular access in patients with end-stage renal disease necessitating dialysis. After a successful kidney transplantation the fistula is no longer needed. In this article we would like to discuss the cardiovascular benefits and potential problems of routine fistula ligation after kidney transplantation.

Methods

A narrative literature search was performed in the literature database of MEDLINE, PubMed and the Cochrane Database of Systematic Reviews up to April 2021.

Results and conclusion

Closure of arteriovenous fistulas in stable kidney transplant recipients reduces pulmonary artery pressure and reduces the risk of right heart failure and therefore achieves a lower cardiovascular risk; however, the decision should be made carefully and individually for each patient.

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Corresponding author

Correspondence to Maria Gummerer.

Ethics declarations

Interessenkonflikt

M. Gummerer, M. Tiefenthaler, C. Margreiter, J. Klocker und S. Wipper geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gummerer, M., Tiefenthaler, M., Margreiter, C. et al. Shuntligatur nach Nierentransplantation: Pro und Kontra. Gefässchirurgie 26, 530–535 (2021). https://doi.org/10.1007/s00772-021-00826-5

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Schlüsselwörter

  • Dialyseshunt
  • Shuntverschluss
  • Herzversagen
  • Nierentransplantation
  • Hämodialyse

Keywords

  • Dialysis shunt
  • Shunt closure
  • Heart failure
  • Kidney transplantation
  • Hemodialysis