Case

60-year-old woman with long hemodialysis vintage and multiple medical/compliance issues rendering her not a candidate for kidney transplant and a poor candidate for PD.

After multiple AVG infections, she is currently dependent on a femoral tunneled catheter for dialysis. After a venous evaluation, including Saphenous vein imaging, no suitable veins were found for an AVF. The use of a saphenous vein allograft available commercially was used as conduit to create a dialysis shunt given its relative resistance to infection.

Peri-operatively, it was hard to type and cross blood for her given the high titers of multiple allo-antibodies. On further review, she was found to have a high historical PRA titer on a previous transplant evaluation.

Given her high allo-immunity, she is likely at high risk of immune failure of her new shunt.

Anybody with the experience of immunosuppression (and with what) in this setting, or using anticoagulation/antiplatelets chronically ? any other approach?

Thank you

PS: no cardiologist or orthopedic surgeon was involved in this case