Vitamin K deficiency with hemorrhage after kidney and combined kidney–pancreas transplantation

Gbks, Prasad; Abidi, Syed Muhammad Ali; McCauley, Jerry; Johnston, James R.

doi:10.1016/s0272-6386(99)70433-6

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Vitamin K deficiency in kidney transplant recipients has been reported previously by means of a coagulopathy responsive to vitamin K treatment in case series [21]. Mazzaferro et al recently argued that total MGP levels in kidney transplant recipients were close to normal [22]; however their study did not differentiate between carboxylated and uncarboxylated MGP which is important given the role for vitamin K in MGP carboxylation.…”

Section: Discussionmentioning

confidence: 94%

Vitamin K Intake and Plasma Desphospho-Uncarboxylated Matrix Gla-Protein Levels in Kidney Transplant Recipients

et al. 2012

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Vitamin K is essential for activation of γ-carboxyglutamate (Gla)-proteins including the vascular calcification inhibitor matrix Gla-protein (MGP). Insufficient vitamin K intake leads to production of uncarboxylated, mostly inactive proteins and contributes to an increased cardiovascular risk. In kidney transplant recipients, cardiovascular risk is high but vitamin K intake and status have not been defined. We investigated dietary vitamin K intake, vascular vitamin K status and its determinants in kidney transplant recipients. We estimated vitamin K intake in a cohort of kidney transplant recipients (n = 60) with stable renal function (creatinine clearance 61 [42–77] (median [interquartile range]) ml/min), who were 75 [35–188] months after transplantation, using three-day food records and food frequency questionnaires. Vascular vitamin K status was assessed by measuring plasma desphospho-uncarboxylated MGP (dp-ucMGP). Total vitamin K intake was below the recommended level in 50% of patients. Lower vitamin K intake was associated with less consumption of green vegetables (33 vs 40 g/d, p = 0.06) and increased dp-ucMGP levels (621 vs 852 pmol/L, p<0.05). Accordingly, dp-ucMGP levels were elevated (>500 pmol/L) in 80% of patients. Multivariate regression identified creatinine clearance, coumarin use, body mass index, high sensitivity-CRP and sodium excretion as independent determinants of dp-ucMGP levels. In a considerable part of the kidney transplant population, vitamin K intake is too low for maximal carboxylation of vascular MGP. The high dp-ucMGP levels may result in an increased risk for arterial calcification. Whether increasing vitamin K intake may have health benefits for kidney transplant recipients should be addressed by future studies.

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Section: Discussionmentioning

confidence: 94%

Vitamin K Intake and Plasma Desphospho-Uncarboxylated Matrix Gla-Protein Levels in Kidney Transplant Recipients

et al. 2012

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“…Dose in adults: 10-20 mg IV slow (maximum 50 mg/day) and 100 mg by mouth. Postoperative administration of parenteral vitamin K can be considered with hemorrhages [ 44 ] .…”

Section: Resultsmentioning

confidence: 99%

Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Santos¹,

Silva²,

Silva³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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IntrodutionAllogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized.ObjectiveTo gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients.MethodsA bibliographic search was conducted using the MeSH term “Blood Transfusion” and the terms “Cardiac Surgery” and “Blood Management.” Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included.ResultsTreating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions.ConclusionThere are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.

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“…Four patients from a total of 146 transplant patients developed vitamin K deficiency induced coagulopathy and bleeding 1-week after transplantation [28]. Haemostatic abnormalities associated with liver transplantation are rather inherently related to different surgical phase of the transplantation and no available data about the vitamin K status post transplantation [26].…”

Section: Fat Soluble Vitaminsmentioning

confidence: 99%

Vitamins Status Following Solid Organ Transplantation

Shawaqfeh¹

2015

J Mol Biomark Diagn

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Solid organ transplantation is a popular solution for many end stage organ failures. The functional evaluation of these transplanted organs is multi-factorial and involves many aspects involving organ function, overall patient wellbeing and quality of life. Literature reports on vitamin status following transplantation had been collected together in this review article. This review summarizes the current status of research in this area with focus on reported deficiencies in vitamins following solid organ transplantation. The deficiencies in either fat-soluble vitamins like vitamin D, vitamin A and vitamin K as well as water soluble vitamins like vitamin B6, vitamin B12 and thiamine have been summarized. The reported deficiencies are noteworthy and necessitate a critical evaluation and interventions in many transplantation programs

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Vitamin K deficiency with hemorrhage after kidney and combined kidney–pancreas transplantation

Cited by 8 publications

References 11 publications

Vitamin K Intake and Plasma Desphospho-Uncarboxylated Matrix Gla-Protein Levels in Kidney Transplant Recipients

Vitamin K Intake and Plasma Desphospho-Uncarboxylated Matrix Gla-Protein Levels in Kidney Transplant Recipients

Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Vitamins Status Following Solid Organ Transplantation

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