Abstract：
BACKGROUND: Cardiovascular disease is the most common cause of death in renal transplant recipients (RTrs). High-output heart failure (HoHF) is a classic problem of RTrs with patent arteriovenous fistulae (AVF). Central to the entire discipline of transplant nephrology is the ligation of AVF in RTrs, with a patent AVF presenting with signs and symptoms of HoHF. AVF ligation has long been a topic of great interest in this population. To date, little attention has been paid to the effects of arteriovenous graft ligation on HoHF. This study systematically reviews the data for AVF ligation, aiming to provide its impact on HoHF in RTrs.
METHODS: The present study adopts the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Published studies were identified using a search strategy in PubMed, Scopus, PubMed Central, Science Direct, and Medline. The primary inclusion criterion for this review was RTrs with a patent AVF who exhibited clinical or imaging findings of HoHF. Articles dating back to the last decade that involved the human species were included in our review, and the search was restricted to the English language. Studies involving both male and female genders and those describing the adult population (aged > 19 years) were also a part of our inclusion criteria.
RESULTS: After applying eligibility criteria, our electronic search yielded 1,461 articles. A total of 16 studies that involved 18,735 subjects were included in our review, which comprised 6 cohort studies, 4 case reports, 2 randomized control trials, 2 narrative reviews, 1 meta-analysis, and 1 case series. While the risk of bias of the narrative reviews was low, 1 of the randomized control trials had some overall concerns. The meta-analysis included in our review had moderate risk of bias, while 4 of the 6 cohort studies were of good quality. All of the case reports and series included in our review were of good quality. Of the 12 studies that reported genders, 10,949 were male and 6,416 were female. There was a notable reduction in left ventricular mass, left ventricular mass index, left ventricular end diastolic dimension, cardiac output, velocity index, and systemic vascular resistance index upon AVF ligation.
CONCLUSIONS: A complete resolution of the clinical signs and symptoms of HoHF can be anticipated after AVF ligation in RTrs. Clinicians should always be on the lookout for signs and symptoms of cardiovascular decompensation in asymptomatic RTrs.
METHODS: The present study adopts the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Published studies were identified using a search strategy in PubMed, Scopus, PubMed Central, Science Direct, and Medline. The primary inclusion criterion for this review was RTrs with a patent AVF who exhibited clinical or imaging findings of HoHF. Articles dating back to the last decade that involved the human species were included in our review, and the search was restricted to the English language. Studies involving both male and female genders and those describing the adult population (aged > 19 years) were also a part of our inclusion criteria.
RESULTS: After applying eligibility criteria, our electronic search yielded 1,461 articles. A total of 16 studies that involved 18,735 subjects were included in our review, which comprised 6 cohort studies, 4 case reports, 2 randomized control trials, 2 narrative reviews, 1 meta-analysis, and 1 case series. While the risk of bias of the narrative reviews was low, 1 of the randomized control trials had some overall concerns. The meta-analysis included in our review had moderate risk of bias, while 4 of the 6 cohort studies were of good quality. All of the case reports and series included in our review were of good quality. Of the 12 studies that reported genders, 10,949 were male and 6,416 were female. There was a notable reduction in left ventricular mass, left ventricular mass index, left ventricular end diastolic dimension, cardiac output, velocity index, and systemic vascular resistance index upon AVF ligation.
CONCLUSIONS: A complete resolution of the clinical signs and symptoms of HoHF can be anticipated after AVF ligation in RTrs. Clinicians should always be on the lookout for signs and symptoms of cardiovascular decompensation in asymptomatic RTrs.
摘要：
背景：心血管疾病是肾移植受者（RTrs）最常见的死亡原因。高输出心力衰竭（HoHF）是具有动静脉瘘（AVF）未闭的RTR的经典问题。整个移植肾脏病学的核心是RTrs中AVF的结扎，具有专利AVF，具有HoHF的体征和症状。AVF结扎长期以来一直是该人群中非常感兴趣的话题。迄今为止,AVG结扎对HoHF的影响很少受到关注。本研究系统地回顾了AVF结扎的数据，旨在提供其对RTR中的HoHF的影响。
方法：本研究采用系统评价和荟萃分析（PRISMA）2020指南的首选报告项目。已发表的研究是使用PubMed中的搜索策略确定的，Scopus,PubMedCentral,科学直接，Medline本综述的主要纳入标准是具有AVF专利的RTR，其表现出HoHF的临床或影像学发现。我们的评论中包括了可以追溯到过去十年中涉及人类物种的文章，搜索仅限于英语。涉及男性和女性性别以及描述成年人口（>19岁）的研究也是我们纳入标准的一部分。
结果：应用资格标准后，我们的电子搜索产生了1461篇文章。共有16项研究涉及18,735名受试者，其中包括六项队列研究，四例病例报告,两个RCT,两个叙事评论，一个荟萃分析，一个案例系列。虽然叙事评论的偏见风险(RoB)很低，其中一个RCT有一些整体问题.我们的综述中包含的荟萃分析具有中等的RoB，而六项队列研究中有四项具有良好的质量。我们审查中包括的所有病例报告和系列报告质量都很好。在12项报告性别的研究中，10949为男性，6416为女性。左心室质量显著减少，左心室质量指数,左心室舒张末期尺寸，心输出量,速度指数,和AVF结扎时的全身血管阻力指数。
结论：在RTrs中进行AVF结扎后，可以预期HoHF的临床体征和症状的完全缓解。临床医生应始终注意无症状RTrs中心血管代偿失调的体征和症状。
方法：本研究采用系统评价和荟萃分析（PRISMA）2020指南的首选报告项目。已发表的研究是使用PubMed中的搜索策略确定的，Scopus,PubMedCentral,科学直接，Medline本综述的主要纳入标准是具有AVF专利的RTR，其表现出HoHF的临床或影像学发现。我们的评论中包括了可以追溯到过去十年中涉及人类物种的文章，搜索仅限于英语。涉及男性和女性性别以及描述成年人口（>19岁）的研究也是我们纳入标准的一部分。
结果：应用资格标准后，我们的电子搜索产生了1461篇文章。共有16项研究涉及18,735名受试者，其中包括六项队列研究，四例病例报告,两个RCT,两个叙事评论，一个荟萃分析，一个案例系列。虽然叙事评论的偏见风险(RoB)很低，其中一个RCT有一些整体问题.我们的综述中包含的荟萃分析具有中等的RoB，而六项队列研究中有四项具有良好的质量。我们审查中包括的所有病例报告和系列报告质量都很好。在12项报告性别的研究中，10949为男性，6416为女性。左心室质量显著减少，左心室质量指数,左心室舒张末期尺寸，心输出量,速度指数,和AVF结扎时的全身血管阻力指数。
结论：在RTrs中进行AVF结扎后，可以预期HoHF的临床体征和症状的完全缓解。临床医生应始终注意无症状RTrs中心血管代偿失调的体征和症状。
