Abstract Number: PB0316
Meeting: ISTH 2020 Congress
Background: Chronic kidney disease results in altered haemostasis with increased risk of venous thromboembolism (VTE) and bleeding. Without thromboprophylaxis, the incidence of VTE post-transplant is estimated at 7.4% and major bleeding 2.1%. Reported incidence for renal allograft thrombosis is between 0.4%- 6%. Currently there is no consensus on optimum thromboprophylaxis strategies post renal transplant and protocols are largely based on guidelines in general surgery patients.
Aims: To evaluate and compare changes in haemostatic parameters in renal transplant recipients and donors at pre-determined time points before and after surgery. This study was approved by the medical ethics committee.
Methods: Single site observational cohort study. After informed consent was obtained, citrated blood samples were collected at admission, immediately post-operatively and at 24 hours for both recipient and donor. Samples at 72 hours and 5 days post-surgery were collected in addition for recipients. Assays performed included D-dimer, prothrombin fragments 1+2 (F1,2), anti-thrombin (AT), von Willebrand factor (vWF) activity and factor VIII activity.
Results: 34 patients recruited (17 recipients and 17 donors). Median age of recipients was 41 years (23-70 years) with a male preponderance (M:F 3:1). Median age of donors was 47 years (26-75 years) with a slight female preponderance (M:F 1:1.4). The average eGFR was 10ml/min in recipients compared to 74ml/min in donors. Improvement in eGFR was noted as early as 24 hours post-surgery with mean value of 77ml/min at 5 days. At admission, levels of all lab parameters assayed were higher in recipients compared to donors. In donors, levels began to taper toward baseline at 24 hours post-surgery but remained persistently elevated in recipients even at 5 days post-transplant. AT levels were lower in recipients compared to controls.
Conclusions: These results show that patients with underlying chronic kidney disease are pro-thrombotic and remain so early post-transplant even with recovery of renal function.
To cite this abstract in AMA style:Kohli R, Platton S, Green L, Maccallum P. Haemostatic Changes in Patients Undergoing Renal Transplantation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/haemostatic-changes-in-patients-undergoing-renal-transplantation/. Accessed September 29, 2023.
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