Changes in hemostatic factors after kidney transplantation: A retrospective cohort study.
Kang Woong JunJinbeom ChoMi Hyeong KimJeong Kye HwangSun Cheol ParkIn Sung MoonJi Il KimPublished in: Medicine (2021)
Chronic kidney disease affects hemostasis in complex ways, producing both thrombotic and hemorrhagic diatheses. These changes may impact patient morbidity and mortality pre-transplantation, as well as allograft survival after kidney transplantation (KT). This study was conducted to analyze changes in hemostatic factors in the early post-KT period.We retrospectively analyzed 676 recipients of kidney allografts from December 2009 to December 2014. Patients receiving plasmapheresis pre- or post-KT, experiencing early allograft failure, or receiving anticoagulants or antiplatelet agents pre- or post-KT were excluded.Of the 367 included patients, acute (≤1 month) rejection occurred in 4.1% and delayed graft function occurred in 3.3%. Postoperative bleeding complications occurred in 7.9% of patients and thrombotic complications in 3.3%. Pre-transplantation, recipients had below normal hemoglobin, above normal d-dimer and homocysteine levels, and elevated rates of antiphospholipid antibodies. Hemoglobin increased to almost normal by postoperative day (POD) 28 (P < .001). d-dimer increased on POD7, 14, and 28, although the values were not significantly different from pre-KT. The pattern of d-dimer changes suggested that they were a nonspecific consequence of major surgery. Homocysteine decreased to normal by POD7 (P < .001). The percentage of patients with ≥1 prothrombotic factor was 82.0% pre-KT and only 14.2% on POD28 (P < .001).The most of patients exhibited prothrombotic tendencies, including increased d-dimer and homocysteine, and increased prevalence of antiphospholipid antibodies before transplantation. They also had pre-transplantation anemia, suggesting a concomitant bleeding diathesis. However, most of these abnormal hemostatic factors improved or resolved after KT.
Keyphrases
- end stage renal disease
- chronic kidney disease
- ejection fraction
- peritoneal dialysis
- newly diagnosed
- systemic lupus erythematosus
- stem cells
- atrial fibrillation
- prognostic factors
- mesenchymal stem cells
- intensive care unit
- risk factors
- minimally invasive
- liver failure
- coronary artery disease
- bone marrow
- cell therapy
- drug induced
- surgical site infection