Vascular Thrombosis After Kidney Transplantation: Predisposing Factors and Risk Index

Luna, Enrique; Cerezo, Isis; Collado, G.; Martinez, Charlie; Villa, Juan Alcibar; Macías, Rosa Galeano; García, Carmen; Cubero, Juan José

doi:10.1016/j.transproceed.2010.07.085

Cited by 20 publications

(19 citation statements)

References 5 publications

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“…Aside from VKA therapy, often indicated in certain cardiovascular diseases, CVD was associated with an increased risk for bleeding, even after correction for VKA or APT, most likely explained by the technical challenges of transplanting patients with a high burden of CVD. A previous study mentioned that pre‐emptive KTx is protective against thrombosis . Interestingly, we saw an increased risk for bleeding in our pre‐emptively transplanted cohort.…”

Section: Discussionsupporting

confidence: 51%

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

et al. 2019

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SummaryPerioperative 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.

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Section: Discussionsupporting

confidence: 51%

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

et al. 2019

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“…Many have reported increased donor age as a risk factor for renal allograft thrombosis [6][7][8]. In the context of EGL, our data indicate that there was no significant difference in donor age between recipients who did not experienced EGL and those who experienced EGL due to thrombosis.…”

Section: Donor Characteristicsmentioning

confidence: 45%

Identifying risk factors for graft loss within 90 days of kidney transplantation in the modern era: A review of single center and UNOS databases

Brooks¹,

Mitro²,

Becker³

et al. 2017

Trends in Transplant

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Aim: Our aim was to clarify the risk factors for graft loss within the first 90 days of kidney transplantation. Methods:We performed an IRB-approved, retrospective review of the United Network for Organ Sharing database (2010)(2011)(2012)(2013)(2014)(2015) and our own single center database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We analyzed risk factors for early graft loss (EGL). EGL was defined as graft loss due to patient death, graft thrombosis, acute rejection, or primary non-function within 90 days of transplantation.Results: At our center, 30 of 676 recipients experienced EGL (4.4%). The most common cause of EGL at our center was recipient death. Demographic variables associated with EGL included: expanded criteria donor (p<0.001), older donors (p=0.003), donors with higher BMI (p=0.004), and higher KDPI (p=0.001). One-, 3-, and 5-year patient survival was lower in recipients with EGL (all p<0.001). Multivariate analysis suggested expanded criteria donor and donor BMI were predictors of EGL (p<0.001).The rate of EGL among patients in the UNOS database was 3.35%, with patient death being the most common cause. Multivariate analysis of the UNOS database revealed only recipient age was a predictor of EGL due to patient death (p<0.001). There were no predictors of EGL due to thrombosis. Previous kidney transplant and recipient age were predictors of EGL due to acute rejection (p=0.002 and p<0.001). Conclusions:Overall between our center and UNOS database, patient death was the most common cause of EGL. Single center and UNOS data suggest that EGL occurs more frequently in recipients of sub-optimal allografts. Additionally, older age and previous transplant is associated with increased risk for EGL.

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“…We identified the degree of immunological mismatch to be significantly associated with non‐salvage of the graft after thrombotic events. Although the degree of mismatch was not associated with development of vascular thrombosis, most probably because of the use of recent immunosuppressive therapy, HLA‐mismatch is associated with antibody‐mediated rejection and possible endothelial dysfunction that might predispose to graft loss after revascularization.…”

Section: Discussionmentioning

confidence: 97%

“…Vascular thrombotic events after renal Tx are devastating complications that are worth analysis because of the high incidence of graft loss. Many recent reports studied the possible risk factors, even constituting a model for identifying recipients with the highest risk of such complications . Nevertheless, none of the previous reports showed the outcome of these events.…”

Section: Discussionmentioning

confidence: 99%

Salvage of grafts with vascular thrombosis during live donor renal allotransplantation: A critical analysis of successful outcome

et al. 2014

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Abbreviations & Acronyms CIA = common iliac artery EIA = external iliac artery EIV = external iliac vein HLA = human leukocyte antigen IIA = internal iliac artery IVC = inferior vena cava LDRTx = live donor renal allotransplantation MRA = magnetic resonance angiography RAT = renal artery thrombosis RVT = renal vein thrombosis Tx = transplantation US = ultrasound WIT = warm ischemia time Objectives: To report a high-volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation. Methods: Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents -renal artery thrombosis and renal vein thrombosis -was carried out. Salvage procedures were recorded and their outcomes were assessed. Results: A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheterdirected thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P = 0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8-8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts. Conclusions: Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.

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Vascular Thrombosis After Kidney Transplantation: Predisposing Factors and Risk Index

Cited by 20 publications

References 5 publications

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

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

Identifying risk factors for graft loss within 90 days of kidney transplantation in the modern era: A review of single center and UNOS databases

Salvage of grafts with vascular thrombosis during live donor renal allotransplantation: A critical analysis of successful outcome

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