The effect of perioperative antiplatelet / anticoagulant therapy on the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation. - A dual center retrospective cohort study of 2000 kidney transplant recipients.

T. van den Berg, R.C. Minnee, G.J. Nieuwenhuijs-Moeke, S.J.L. Bakker, R.A. Pol

Friday 16 march 2018

10:40 - 10:50h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 13: Clinical

Thromboembolic complications (TECs) are dreaded complications after kidney transplantation (KTx). Although incidence is low, consequences are severe and can result in delayed function or even graft loss. The perioperative use of anticoagulation may play a role in this, but a national protocol is missing due to lack of consensus on postoperative bleeding risks.

Our objective was to determine the incidence of TECs and bleeding in relation to the use of pre- and intraoperative antiplatelet/anticoagulation therapy in KTx and to identify risk factors. All patients >18 years, who underwent a living or deceased KTx between 2011-2016 in 2 centers, were included and retrospectively analyzed. Exclusion criteria were combined transplantations or missing data on antiplatelet/-coagulative therapy. Data from electronical databases and patient registries were merged. Events were scored in case of occurrence ≤7 days post-transplantation. TECs were defined as an arterial/venous renal thrombosis, deep venous thrombosis or pulmonary embolism. Bleeding complications were scored after confirmation with imaging. Primary outcome parameters were the incidence of TECs and bleeding in relation to the use of pre-/intraoperative anticoagulation. Secondary outcome parameters were risk factors correlated to TECs and postoperative bleeding. Statistical analyses were performed with SPSS Statistics 23.0. Two thousand patients were included and stratified for TEC or bleeding. Of all patients 59% was male, mean age was 55±14 years and 60% received a living donor kidney, 20% a DBD kidney and 20% a DCD kidney.

TEC≤7 days occurred in 21 (1.1%) patients. Bleeding≤7 days occurred in 87 (4.4%) patients. Univariate regression analysis for TEC identified (P<0.05) multiple donor arteries (odds ratio (OR) 2.79) and recipient obesity (BMI≥30 kg/m², OR 2.85) as potential risk factors. Multivariate regression analysis for postoperative bleeding identified (Bonferroni adjusted P<0.004) cardiovascular disease (OR 2.30) and preemptive transplantation (OR 2.35) as potential risk factors. Use of intraoperative heparin, vitamin K antagonists or antiplatelet therapy showed no increased risk for bleeding (P>0.05)

Conclusion
Our results show that TECs occur in 1.1% and bleeding in 4.4% of kidney transplantations. Intraoperative heparin and continued use of platelet aggregation inhibitors does not lead to an increased risk of bleeding. Therefore, administration of these regimens to prevent TECs appears to be safe.