Changes in hemostatic factors after kidney transplantation: A retrospective cohort study. Issue 36 (10th September 2021)

• Record Type: Journal Article
• Authors: Jun, Kang Woong; Cho, Jinbeom; Kim, Mi Hyeong; Hwang, Jeong Kye; Park, Sun Cheol; Moon, In Sung; Kim, Ji Il
• Other Names: Chen. Robert section editor.
• Is Part Of: Medicine. Volume 100:Issue 36(2021)
• Publication Date: 2021-09-10
• Subjects: chronic kidney disease -- end stage renal disease -- hemostatic factors -- kidney transplantation; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000027179
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: 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.