Renal transplant and hemostasis: early postoperative changes in recipients and donors

Ruchika Kohli; Sean Platton; Suzanne Forbes; Raj Thuraisingham; Joachim Tan; Laura Green; Peter MacCallum

doi:10.1016/j.rpth.2023.100168

Renal transplant and hemostasis: early postoperative changes in recipients and donors

Res Pract Thromb Haemost. 2023 Apr 26;7(4):100168. doi: 10.1016/j.rpth.2023.100168. eCollection 2023 May.

Authors

Ruchika Kohli¹, Sean Platton², Suzanne Forbes², Raj Thuraisingham², Joachim Tan³, Laura Green^{2

4

5}, Peter MacCallum^{1

2}

Affiliations

¹ Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
² Barts Health NHS Trust, London, United Kingdom.
³ St. Georges, University of London, London, United Kingdom.
⁴ Blizard Institute, Queen Mary University of London, London, United Kingdom.
⁵ NHS Blood & Transplant, London, United Kingdom.

Abstract

Background: The benefit of administering pharmacologic thromboprophylaxis following renal transplantation remains uncertain.

Objectives: To compare hemostatic parameters before and after renal transplant surgery in both recipients and their donors at predetermined time points.

Methods: Blood samples were collected at baseline (T1), immediately after surgery (T2), and at 24 hours after surgery (T3) in both recipients and donors and at 72 (T4) and 120 hours (T5) from recipients only. Assays included in vitro thrombin generation, factor VIII (FVIIIc) activity, von Willebrand factor (VWF) antigen, D-dimer, antithrombin activity, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes, and plasminogen activator inhibitor-1 (PAI-1) antigen.

Results: Fifty-two patients (28 recipients and 24 donors) were enrolled. Both donors and recipients had increased FVIIIc, VWF, F1 + 2, D-dimer, and PAI immediately after surgery but reduced antithrombin. Mixed-model analysis showed that the magnitude of change over time (between T1 and T3) for FVIIIc (mean estimated difference [MED], 72; 95% CI, 41-102; P < .0001), VWF (MED, 89; 95% CI, 35-142; P = .001), F1 + 2 (MED, 283; 95% CI, 144-422; P < .0001), thrombin-antithrombin complexes (MED, 3.5; 95% CI, 1.9-5.1; P < .0001), D-dimer (MED, 2.2; 95% CI, 1.0-3.3; P < .0001), PAI-1 (MED, 9.2; 95% CI, 3.4-14.9; P = .002), and time to peak thrombin generation (MED, 1.5; 95% CI, 0.35-2.7; P = .01) was more significant in recipients than in donors.

Conclusion: Persistence of a hypercoagulable state was more prominent in recipients after 24 hours despite recovery in renal function and initiation of thromboprophylaxis.

Keywords: hemostasis; recipients; renal transplant; thrombin generation; thromboprophylaxis.