Clinical studies of hemodialysis access through formaldehyde-fixed arterial allografts

Efficient hemodialysis requires establishing a permanent stable vascular access. Our study was designed to evaluate formaldehyde-fixed arterial allografts as hemodialysis access for end-stage renal disease. Various parameters were determined for 68 formaldehyde-fixed, cadaver-derived allografts transplanted into 43 hemodialysis patients. The sources of the allografts were determined to be free of cytomegalovirus, hepatitis B and hepatitis C, and HIV infections. These allografts were monitored for rejection, blood flow, patency rates, and complications. Overall, antigenicity of the allografts was reduced after formaldehyde fixation with no acute rejection. The mean access blood flow was 696±282 ml with reasonable primary and secondary patency rates even after 3 years. Allograft intimal hyperplasia, determined by immunohistochemistry, was evident as the proliferation of smooth muscle-like cells expressing actin but cells not expressing the endothelial markers von Willebrand factor or CD34. The incidence of thrombus formation was about 37% after allograft transplant with other limited complications of pseudoaneurysms and local infection. Our results support the clinical use of formaldehyde-fixed arterial allografts for hemodialysis access.