Heterozygous Prothrombin Gene Mutation: A New Risk Factor for Early Renal Allograft Thrombosis

Oh, Jun; Schaefer, F.; Veldmann, Alex; Nowak, G; Nowak-Göttl, U.; Tönshoff, B.; Kreuz, W.

doi:10.1097/00007890-199908270-00022

Cited by 33 publications

(24 citation statements)

References 17 publications

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“…There are various risk factors for the occurrence of transplant thromboses. The following factors can have an influence: deceased donation, cold ischaemia time >24 h, multiple transplants, peritoneal dialysis, more than 5 blood transfusions, donor age or recipients <6 years, thrombophilia and low blood pressure during transplantation [4, 7, 17]. In order to avoid thromboses or renal artery stenosis, especially in cases of young recipients (age <9 years), the cold ischaemia time should be as short as possible.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up after Paediatric Kidney Transplantation and Influence Factors on Graft Survival: A Single-Centre Experience of 16 years

et al. 2018

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Introduction: To evaluate graft- and patient survival after paediatric kidney transplantation and detecting influence factors, which affect the post-transplant time. Materials and Methods: We analysed long-term survival rates and complications after paediatric kidney transplantation and searched for predictive parameters for graft function. Results: In 132 patients, 143 kidney transplantations were performed. Graft failure occurred in 25%. Chronic rejections were the leading cause of graft loss (42.9%). Graft survival rates were 92.2% after 1 year, 85.5% after 5 years, 71.1% after 10 years and 62.1% after 15 years. The following parameters strongly influenced graft survival: number of transplants (p = 0.014), year of transplant (p < 0.0001 for 1997–2005), Epo-therapy post-transplant (p = 0.001), hypotension donor (p = 0.027), cold ischemia time (p = 0.023), anastomosis time >50 min (p = 0.008), delayed graft function (p = 0.003) and deceased donation (p = 0.039). The percentage of patients who died was 5.6%. Overall patient survival rates were 99.3% after 1 year, 95.2% after 5 years, 94.2% after 10 years and 90.7% after 15 years. Various types of infections (42.9%) were the main causes of death. Conclusions: The main causes of death after kidney transplantations in paediatric recipients are malignancy and infections. To avoid vascular complications especially in young recipients (<9 years), the cold ischemia time should be as short as possible.

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Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up after Paediatric Kidney Transplantation and Influence Factors on Graft Survival: A Single-Centre Experience of 16 years

et al. 2018

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“…Prothrombin gene G 20210A polymorphism can be used as a marker for transplant thrombosis as suggested by Oh et al [20] and later confirmed by Fischereder et al [21] and Heidenreich et al [22]. The presence of this mutation in a kidney transplant patient was shown to result in a shorter graft survival (median 65.9 vs 149 months) [21].…”

Section: Thrombophilia (Figure 1)mentioning

confidence: 92%

Do we need screening for thrombophilia prior to kidney transplantation?

Andrassy¹

2004

Nephrology Dialysis Transplantation

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Background. There is increased risk for the occurrence of deep venous thrombosis (DVT) and renovascular thrombosis after kidney transplantation. A disruption of the blood homeostasis caused by surgery and leading to clotting and bleeding malfunctions is widely accepted. However, other causes such as inherited or acquired disorders of the clotting system may further increase the risk of thrombosis. Here, we summarize and review data on possible causes, incidence and ways to prevent the occurrence of DVT and/or renovascular thrombosis after kidney transplantation. Results. The incidence of DVT after kidney transplantation is 6.2-8.3% and 25% of these patients suffer from pulmonary embolism. The DVT occurs primarily on the side of the transplant with an increased risk throughout the first 5 months after transplantation. Thereby, 2-12% of the patients develop renovascular thromboses, most of which are related directly to the surgery. However, inherited or acquired thrombophilia may also play an important role. A severe course is known for prothrombin gene G20210A polymorphism, which can result in graft loss. A great diversity of prophylactic treatments is available but adjustment to the underlying circumstances is crucial for a favourable outcome. Low-dose heparin prophylaxis for at least 2-3 weeks can be used as standard therapy to prevent the occurrence of DVT after kidney transplantation. However, this may not be sufficient for concurrent disorders of the blood homeostasis such as elevated levels of antiphospholipid antibodies, lupus anticoagulant, prothrombin gene G20210A polymorphism or a combined inherited thrombophilia. These patients may need a prophylactic anticoagulation with coumarins starting prior to transplantation and being continued for at least 1 year or even lifelong. Only randomized trials can answer the question concerning optimal duration and safety of coumarins in this setting.Conclusions. DVT and/or renovascular thromboses are severe complications after kidney transplantation. Inherited and acquired thrombophilia, apart from surgery and abnormal anatomy itself, have to be considered and proper prophylactic treatment initiated.

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“…The current evidence implicating the prothrombin gene mutation in complications after renal transplantation is limited to a few case reports and one retrospective study (18,19). Most studies of thrombophilia in renal transplant recipients did not include testing for this mutation.…”

Section: Factor V Leidenmentioning

confidence: 99%

Thrombophilia and Thrombotic Problems in Renal Transplant Patients

Kujovich¹

2004

Transplantation

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Heterozygous Prothrombin Gene Mutation: A New Risk Factor for Early Renal Allograft Thrombosis

Abstract: The prothrombin gene mutation is a new risk factor for thrombotic complications both on hemodialysis and after renal transplantation. It may be useful to screen for this disorder in the pretransplant thrombophilia work-up.

Cited by 33 publications

References 17 publications

Long-Term Follow-Up after Paediatric Kidney Transplantation and Influence Factors on Graft Survival: A Single-Centre Experience of 16 years

Long-Term Follow-Up after Paediatric Kidney Transplantation and Influence Factors on Graft Survival: A Single-Centre Experience of 16 years

Do we need screening for thrombophilia prior to kidney transplantation?

Thrombophilia and Thrombotic Problems in Renal Transplant Patients

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