Thrombophilic Factors Do Not Predict Outcomes in Renal Transplant Recipients Under Prophylactic Acetylsalicylic Acid

Abstract

A cohort of recipients of renal transplant after 2000 (N = 310) was prospectively screened on the day of transplantation and 1 month later for a panel of 11 thrombophilic factors to assess their effect on posttransplant outcomes. All patients received prophylactic acetylsalicylic acid, started before transplantation.The rate of thromboembolic events or acute rejection episodes during the first posttransplant year (primary composite endpoint) was 16.7% among patients free of thrombophilic factor (N = 60) and 17.2% in those with ≥1 thrombophilic factor (N = 250) (p > 0.99). The incidence of the primary endpoint was similar among patients free of thrombophilic factors and those with ≥2 (N = 135), or ≥3 (N = 53) factors (16.3% and 15.1% respectively; p = 1) and in patients who remained thrombophilic at 1 month (15.7%; p = 0.84). None of the individual thrombophilic factor present at the day of transplantation was associated with the primary endpoint. The incidence of cardiovascular events at 1-year, serum creatinine at 1-year, 4-year actuarial graft and patient survival were not influenced by the presence of ≥1 thrombophilic factor at baseline (p = NS).In conclusion, the presence of thrombophilic factors does not influence thromboembolic events, acute rejection, graft or patient survival in patients transplanted after 2000 and receiving prophylactic acetylsalicylic acid.

Thrombophilic factors in Stage V chronic kidney disease patients are largely corrected by renal transplantation

“…We recently reported on a cohort study where 310 renal transplant recipients were prospectively screened on the day of transplantation for a panel of 11 inherited and acquired thrombophilic factors. One crucial finding was that 80% of the patients from this cohort had at least one thrombophilic factor [3]. Important questions remain regarding CKD-acquired thrombophilic factors.…”

“…In addition, antiphospholipid antibodies and lupus anticoagulant are the main acquired thrombophilic factors associated with an increased thromboembolic risk [1,2]. For largely unknown reasons, the prevalence of acquired thrombophilic factors is higher in patients with Stage V chronic kidney disease (CKD) [3][4][5][6][7][8][9][10] than in the general population [2]. The possible impact of thrombophilic factors on the incidence of thromboembolic events, either during dialysis or early after kidney transplantation, is the subject of contradictory findings [3,4,[11][12][13][14][15][16][17][18][19].…”

Molecularly targeted therapies for p53-mutant cancers

“…The Toll-like receptors (TLR) plays important role in activating early innate immunity in response to different pathogens and orchestrating late adaptive immune responses (126, 127). The functions of at least two TLRs including TLR4 and TLR3 have been linked to mutant p53 cancers.…”

“…The functions of at least two TLRs including TLR4 and TLR3 have been linked to mutant p53 cancers. Toll-like receptor 4 (TLR4) is expressed on the cell surface of immune cells to activate innate immune response to gram-negative bacterial lipopolysaccharide (LPS) (126, 127). It is also expressed in breast epithelial tumors, and has oncogenic functions to promote tumor growth and drug resistance (128).…”

End-stage renal disease and thrombophilia

“…However, in individuals homozygous for the MTHFR T677T genotype the risk of vascular rejection was increased (42). Retrospective cohort studies reporting vascular graft thrombosis between 2007 and 2011 showed a lower incidence of vascular complications following KT (32,38,48) and a lower rate of inherited thrombophilic gene mutations associated with graft thrombosis, discussing that change of treatment modalities may have influenced this shift (32,48,49).…”