Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation - a retrospective study

Abstract

Perioperative antithrombotic therapy could play a role in preventing thromboembolic complications (TEC) after kidney transplantation (KTx), but little is known on postoperative bleeding risks. This retrospective analysis comprises 2000 single-organ KTx recipients transplanted between 2011 and 2016 in the two largest transplant centers of the Netherlands. TEC and bleeding events were scored ≤7 days post-KTx. Primary analyses were for associations of antithrombotic therapy with incidence of TEC and bleeding. Secondary analyses were for associations of other potential risk factors. Mean age was 55 ± 14 years, 59% was male and 60% received a living donor kidney. Twenty-one patients (1.1%) had a TEC. Multiple donor arteries [OR 2.79 (1.15-6.79)] and obesity [OR 2.85 (1.19-6.82)] were identified as potential risk factors for TEC. Bleeding occurred in 88 patients (4.4%) and incidence varied significantly between different antithrombotic therapies (P = 0.006). Cardiovascular disease [OR 2.01 (1.18-3.42)], pre-emptive KTx [OR 2.23 (1.28-3.89)], postoperative heparin infusion [OR 1.69 (1.00-2.85)], and vitamin K antagonists [OR 6.60 (2.95-14.77)] were associated with an increased bleeding risk. Intraoperative heparin and antiplatelet therapy were not associated with increased bleeding risk. These regimens appear to be safe for the possible prevention of TEC without increasing the risk for bleeding after KTx.

Keywords: anticoagulation; bleeding; kidney transplant; risk factors; thrombosis.

Figure 1

Incidence (%) of thromboembolic complications per treatment group. TEC, thromboembolic complications; APT, antiplatelet therapy; VKA, Vitamin K antagonists; UFH, unfractionated heparin (given intraoperatively).

Figure 2

Number of TEC and bleeding per day after transplantation. n, number of group; TEC, thromboembolic complication.

Figure 3

Incidence (%) of bleeding per treatment group. APT, antiplatelet therapy; VKA, Vitamin K antagonists; UFH, unfractionated heparin (given intraoperatively).