O061 A single-centre retrospective study in a large tertiary renal centre on the management of infected arteriovenous grafts

Introduction

Prosthetic arteriovenous grafts (AVGs) are often used as tertiary vascular access for haemodialysis in patients with exhausted autogenous options. AVGs are associated with an increased risk of infection which can lead to excess morbidity and life-threatening complications. Infected AVGs are challenging to manage, and the current evidence remains unclear on optimal strategy with arguments for conservative management, salvaging with revision or surgical excision (subtotal or total). This study sought to evaluate the management of infected AVGs by examining the clinical outcomes of patients with infected AVGs managed in our institution.

Methods

We conducted a single-centre retrospective study of all AVG infections managed (conservative management via antibiotics; graft revision; surgical excision) between June 2016 to May 2021. Primary outcome was mortality at 1 year. Secondary outcome was functional vascular access at 6 months and 1 year. Data were extracted from electronic patient records, radiology imaging and reporting.

Results

34 patients were included in our study (14.7% conservatively managed; 14.7% revision; 70.6% surgical excision) with a mean age of 60.4 ± 14.4 years (67.6% males). Average time from AVG placement to presentation was 11.8 months. 1 year mortality was 14.7%. Functional vascular access at 6 months in the three groups was 60%, 60% and 10% and 1-year functional vascular access was 60%, 75% and 42% respectively.

Conclusion

Surgically excised infected AVGs are associated with poor 6-month and 1-year vascular access outcomes. The findings suggest that conservative management and/or revision are more prudent given their higher probability of subsequent functional access.

Take-home message

Provision of a definite vascular access within the first year of graft infection is highly challenging. As such, conservative management and graft revision present as superior options to manage infected arteriovenous grafts.

Experience of SARS-CoV-2 infection in two kidney transplant recipients living with HIV-1 infection

There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.

Predictive Factors of Pancreatic Fistula After Pancreaticoduodenectomy and External Validation of Predictive Scores

BACKGROUND/AIM

The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort.

PATIENTS AND METHODS

The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores.

RESULTS

In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R²=0.596, p=0.001), Wellner's score (R²=0.285, p=0.005) and Roberts' score (R²=0.385, p=0.002) correlated with the likelihood of developing CR-POPF.

CONCLUSION

Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.

Therapeutic kidney donation: a potential source of precious organs

The number of patients awaiting a renal transplant considerably exceeds the number of organ grafts available. A successful kidney transplant is the most clinically and cost effective treatment for patients with end stage renal disease. A proportion of patients currently die awaiting a renal transplant as their continues to be a global deficiency of renal allografts. Efforts continue to be made in order to improve the current situation of waiting lists and there is now an urgent clinical need to explore potential new sources to increase the number of renal allografts for transplantation. We describe a successful case of a renal transplant with a kidney removed for benign aetiology and transplanted into a patient who was on the cadaveric renal transplant waiting list for 6 years. We predict that this of ‘Altruistic domino donation’ concept could potentially reduce the waiting list for cadaveric renal transplantation and more importantly become a valuable source for new renal allografts.

Renal transplantation with kidneys affected by tumours

Renal transplantation confers improvement in quality of life and survival when compared to patients on dialysis. There is a universal shortage of organs, and efforts have been made to overcome this shortage by exploring new sources. One such area is the use of kidneys containing small tumours after resection of the neoplasm. This paper looks at the current evidence in the literature and reviews the feasibility of utilizing such a source.