Relevance of Inherited Thrombophilia Screening in Adult Kidney Transplant Recipients

Abstract

Objectives: Thrombophilia has been implicated in posttransplant thrombosis. Data concerning the impact of thrombophilia on thrombotic risk in renal graft recipients are inconclusive. We evaluated whether identification of thrombophilia in patients during pretransplant laboratory screening was a predictor of posttransplant outcomes.

Materials and methods: We conducted a prospective single-center longitudinal study that included adult recipients who underwent kidney transplant from January 2011 to December 2017. Cardiovascular risk factors, personal history of thrombosis, and data concerning kidney transplant episodes were recorded. Before kidney transplant, all patients were systematically screened for thrombophilia. For thrombophilia screening for antithrombin, protein C, protein S deficiencies, and activated protein C resistance, reagents from Stago were used (Stachrom AT, Staclot Protein C, Staclot Protein S, and Staclot APCR). The endpoint was a thrombotic event within 2 years after kidney transplant.

Results: Among 75 end-stage renal disease candidates for kidney transplant, 46 kidney transplant recipients were screened for thrombophilia. Thirty-six of the patients were men. The median age was 37 years (interquartile range, 33-43 years). Renal replacement therapy (36 hemodialysis and 10 peritoneal dialysis) was started in all patients. Forty-five patients received a kidney from a living donor. Among the 46 patients, 4 (9%) had a thrombophilia abnormality (3 with protein C deficiency and 1 with activated protein C resistance). Thrombotic events occurred during the follow-up in 7 cases (15%) with no anterior thrombophilia abnormality; 2 of these concerned the kidney transplant. Only 1 patient had loss of kidney graft immediately after kidney transplant. There was no association between pretransplant thrombophilia and posttransplant thrombotic events.

Conclusions: Our results suggest that the utility of universal, comprehensive preoperative thrombophilia testing is not beneficial to determine risk of postoperative thrombosis. Thrombophilia testing may be considered in a select population with a history of pretransplant thrombotic events.