Transurethral resection of the prostate in kidney transplant recipients: urological and renal functional outcomes at long-term follow-up

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Background: The long-term effects of arteriovenous fistula (AVF) ligation on cardiovascular structure following kidney transplantation remain uncertain. The prospective randomized control trial (RCT) by Rao et al examined the effect of AVF ligation at 6 months, on cardiovascular magnetic resonance imaging (CMR)-derived parameters in 27 kidney transplant recipients, compared to 27 controls. A mean decrease in left ventricular mass (LVM) of 22.1 g (95% CI, 15.0 to 29.1) was observed compared to an increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). We conducted a long-term follow-up observational cohort study in the treated cohort to determine the evolution of CMR-derived parameters compared to those documented at 6 months post-AVF ligation. Methods: We performed CMR imaging at long-term follow-up in the AVF ligation observational cohort from our original RCT published in 2019. Results were compared to CMR imaging at 6 months post intervention. The co-primary endpoint was the change in CMR-derived LVM and LVM index at long term follow-up from imaging at 6 months post index procedure. Results: At a median of 5.1 years (interquartile range 4.7-5.5 years), 17 patients in the AVF ligation group were studied with repeat CMR imaging with a median duration to follow-up imaging of 5.1 years (IQR 4.7-5.5 years). A statistically significant further reduction in LVM (-17.6±23.0 g, P=0.006) and LVM index (-10.0±13.0 g/m2, P=0.006) was documented. Conclusion: The benefit of AVF ligation on LVM and LVM index regression appears to persist long-term. This has the potential to lead to a significant reduction in cardiovascular mortality.


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