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Zhao S, Chen H, Shi X, Tan Q, Gu B. Incidence and risk factors of venous thromboembolism in kidney transplantation patients: a prospective cohort study. J Thromb Thrombolysis 2024; 57:278-284. [PMID: 38017304 DOI: 10.1007/s11239-023-02911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/30/2023]
Abstract
To investigate the incidence and explore the risk factors of venous thromboembolism (VTE) within 6 months after kidney transplantation. Total of 331 kidney transplant recipients were assessed by venous ultrasonography for VTE at 14 days, 1 month, 3 months, and 6 months post-transplantation. Cox forward regression were used to identify the independent risk factors of VTE. This study registration number is ChiCTR1900020567 and the date of registration was 2019/01/08. The cumulative incidence of VTE was 2.72% (9/331) within 6 months after transplant. 77.8% (7/9) of VTEs occurred in the first 3 months post-transplantation. 88.9% (1/9) of VTEs were asymptomatic, 66.7% (6/9) of VTEs were mural thromboses and in the right lower extremity. Central vena catheterization (HR = 6.94) and severe pulmonary disease (including pneumonia) (HR = 57.35) were the risk factors for VTE in kidney transplantation recipients. KT patients are the high risk population of VTE. Future interventions should be strengthen for KT patients to receive a minimum of 3-month of precautionary measures for VTE, including infection prevention, and strengthening thromboprophylaxis on the CVC or transplanted side of lower extremity.
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Affiliation(s)
- Shangping Zhao
- West China School of Nursing, Sichuan University/Ward of Nephrology and Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Chen
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoying Shi
- West China School of Nursing, Sichuan University/Ward of Nephrology and Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiling Tan
- West China School of Nursing, Sichuan University/Ward of Nephrology and Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Gu
- West China School of Nursing, Sichuan University/Ward of Nephrology and Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Santoro F, Casanova A, Simone S, Alfieri C, Falcone A, Dello Strologo A, Grandinetti V, Busutti M, Comai G, Marvulli TM, Zippo MG, Castellano G, La Manna G, Gesualdo L, Giuseppe G, Pesce F. Immunosuppressive therapy and oral anticoagulation in kidney transplant recipients: Direct oral anticoagulants versus vitamin-k antagonists. Eur J Intern Med 2024; 119:71-77. [PMID: 37573220 DOI: 10.1016/j.ejim.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND direct oral anticoagulants (DOACs) are an alternative to conventional antagonist of vitamin-K (AVK). However, immune suppressive drugs (ISDs) may interfere with DOACs pharmacokinetic. AIM OF THIS STUDY evaluate safety and efficacy profile of DOACs compared to AVK in kidney transplant recipients (KTRs) treated with ISDs. METHODS a multi-center study from 4 Italian University hospitals enrolling consecutive KTRs on DOACs or AVK was carried out. Sixty-six patients on DOACs were compared with fifty patients on AVK with similar clinical features. Serial evaluation of renal function and serum levels of ISDs during 18 months follow-up (FU) was performed. RESULTS Mean age of DOACs patients was 67±9 and mean eGFR was 58,3± 30,4mL/min/1.73m2. ISDs included tacrolimus (n=47, 71%), cyclosporin (n=13, 20%), everolimus (n=10, 7%) and sirolimus (n=4, 6%). After 14 days of DOACs therapy initiation there was a slight increase of serum levels of tacrolimus (+0.19±0.67 p=0.80) and cyclosporine (+0.12±0.25 p=0.94) not statistically significant. Levels of Tacrolimus and cyclosporin were stable at serial evaluation during 18-months follow-up. There were no thromboembolic events among patients treated with DOACs or AVK and no differences in term of major bleeding (6% vs 4% p=0.69), at long-term follow-up. There was no difference in term of eGFR decline from start therapy to 18 months FU between DOACs vs AVK therapy (-3.9±1 vs -3.8±2 p=0.82). CONCLUSION DOACs have similar safety and efficacy than AVK among KTRs treated with ISDs. However, careful evaluation of potential drug interaction and ISDs serum levels is needed.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical sciences, University of Foggia, Italy;.
| | - Annalisa Casanova
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Carlo Alfieri
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Adele Falcone
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Andrea Dello Strologo
- Department of Translational Medicine and Surgery, University Cattolica Sacro Cuore, Rome, Italy;.
| | - Valeria Grandinetti
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Marco Busutti
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tommaso Maria Marvulli
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Maria Grazia Zippo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Giuseppe Castellano
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of medical and surgery sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Grandaliano Giuseppe
- Department of Translational Medicine and Surgery, University Cattolica Sacro Cuore, Rome, Italy;; Nephrology Unit, Dept. of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS.
| | - Francesco Pesce
- Division of Renal Medicine, "Fatebenefratelli Isola Tiberina-Gemelli Isola", Rome, Italy.
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Bhargava V, Meena P, Bhalla AK, Rana DS, Gupta A, Malik M, Gupta A, Tiwari V. Prevalence, risk, and outcomes of venous thromboembolic events in kidney transplant recipients: a nested case-control study. Ren Fail 2023; 45:2161395. [PMID: 36688793 PMCID: PMC9873273 DOI: 10.1080/0886022x.2022.2161395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Thromboembolism is more common in kidney transplant recipients (KTRs) than in the general population. Studies evaluating arterial and venous thromboembolism (VTE) in KTRs are scarce and the magnitude and risk factors are mostly undefined. METHODS A nested control study was conducted from January 1, 2007, to December 31, 2019. Adult KTRs who were detected to have VTE events during this period were included. The primary outcome was to assess the prevalence of VTE in this population. Secondary outcomes were the assessment of the time to occurrence of the thromboembolic events after transplantation and assessing the risk factors and patient survival. For each subject studied, 4 controls were matched from the data set. RESULTS Amongst 2158 patients, 97 (4.5%) were found to have VTE. The median follow-up time was 3.9 years (6-156 months). A total of 101 VTE events were recorded. The most common site of VTE was the lower limb deep vein thrombosis in 79 patients (0.03%)).In multivariate Cox regression analysis, serum creatinine of more than 3 mg/dl [HR 1.30, 95% CI (1.03-1.38)] was independently associated with increased VTE risk. Patients who developed a VTE had higher mortality as compared to patients who did not develop VTE. No increased risk of graft failure was found in VTE patients. CONCLUSION This study suggests that kidney transplantation surgery is a moderate risk factor for VTE, and VTE is associated with higher morbidity and mortality. However, prospective studies are needed to establish a definite role of VTE in outcomes in KTRs.
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Affiliation(s)
- Vinant Bhargava
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Priti Meena
- All India Institute of Medical Sciences, Bhubaneswar, India,CONTACT Priti Meena All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | - Ashwani Gupta
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Manish Malik
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Anurag Gupta
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Vaibhav Tiwari
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
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Sakowitz S, Bakhtiyar SS, Verma A, Kronen E, Ali K, Chervu N, Benharash P. Risk and factors associated with venous thromboembolism following abdominal transplantation. Surg Open Sci 2023; 13:18-23. [PMID: 37091740 PMCID: PMC10119681 DOI: 10.1016/j.sopen.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 04/25/2023] Open
Abstract
Background Venous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort. Methods The 2014-2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes. Results Of ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25-1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34-1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02-1.63), coagulopathies (AOR 1.63, 95%CI 1.38-1.92), previous history of VTE (AOR 1.14, 95%CI 1.06-1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07-3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07-10.10), as well as infectious (AOR 2.59, 95%CI 1.55-4.21), cardiac (AOR 2.59, 95%CI 1.39-4.82), and respiratory (AOR 1.78, 95%CI 1.21-2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32-15.41), expenditures (+$42,000, 95%CI $24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32-15.41). Conclusions VTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, CA, United States of America
- Corresponding author at: UCLA Division of Cardiac Surgery, 64-249 Center for Health Sciences, Los Angeles, CA 90095, United States of America.
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Massicotte-Azarniouch D, Sood MM, Fergusson DA, Chassé M, Tinmouth A, Knoll GA. The association of venous thromboembolism with blood transfusion in kidney transplant patients. Transfusion 2022; 62:2480-2489. [PMID: 36325656 DOI: 10.1111/trf.17154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Red blood cell transfusion (RBCT) is common after kidney transplantation and could have pro-thrombotic effects predisposing to venous thromboembolism (VTE). The risks for developing of VTE after RBCT in kidney transplant patients are unknown. STUDY DESIGN AND METHODS This was a retrospective cohort study of adult kidney transplant recipients from 2002 to 2018. The exposure of interest was receipt of RBCT after transplant. Cox proportional hazards models were used to calculate hazard ratios (HR) for the outcomes of venous thromboembolism [VTE] (deep venous thrombosis [DVT] or pulmonary embolism [PE]) using RBCT as a time-varying, cumulative exposure. RESULTS Out of 1258 kidney transplants recipients, 468 (37%) were transfused during the study period. Seventy-nine study participants (6.3%) developed VTE, 72 DVT (5.7%), and 22 PE (1.8%). For the receipt of 1, 2, 3-5, and >5 RBCT, compared to individuals never transfused, the number of events and adjusted HR (95%CI) for VTE were 6 (6.2%) HR 1.57 (0.69-3.58), 9 (7.6%) HR 2.54 (1.30-4.96), 15 (11.9%) HR 2.73 (1.38-5.41), and 23 (18.1%) HR 5.77 (2.99-11.14) respectively; for DVT, it was 6 (6.2%) HR 1.94 (0.84-4.48), 9 (7.6%) HR 2.92 (1.44-5.94), 14 (11.1%) HR 3.29 (1.63-6.65), and 21 (16.5%) HR 6.97 (3.53-13.76), respectively. For PE, among transfused individuals, there were 14 events (3.0%) and the HR was 2.40 (1.02-5.61). CONCLUSION The risks for developing VTE, DVT, and PE were significantly increased in kidney transplant patients receiving RBCT after transplant. Receipt of RBCT should prompt considerations for judicious monitoring and assessment for thrombosis.
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Affiliation(s)
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alan Tinmouth
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Beyer-Westendorf J, Marten S, Naue C, Köhler C, Tittl L, Bornhäuser M. Edoxaban dosing patterns in real life practice – Results from the DRESDEN NOAC REGISTRY. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Parker K, Chu J, Morton M, Bhutani S, Picton M, Mitra S, Thachil J. Can direct oral anticoagulants be used in kidney transplant recipients? Clin Transplant 2021; 35:e14474. [PMID: 34498777 DOI: 10.1111/ctr.14474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kidney transplant recipients(KTRs) are at an increased risk of venous thromboembolism (VTE) and atrial fibrillation(AF). Direct oral anticoagulants (DOACs) have shown important advantages over vitamin K antagonists; however, in KTRs, concerns regarding interactions and use in severe kidney disease may limit their use. This evaluation describes a large UK kidney transplant center's experience of DOACs in KTRs with CrCl > 15 mL/min. METHODS Electronic records were reviewed for all adult KTRs at Manchester University Foundation Trust Hospitals taking DOACs between January 2018 and October 2020 with VTE or AF. The primary outcome was trough and peak DOAC levels within the expected reference ranges and secondary outcomes included bleeding and thrombotic events. RESULTS In 31 KTRs taking DOACS, eight patients had a CrCl < 30 mL/min. Overall, 94% (62/66) of DOAC levels were within the recommended ranges. There were no thrombotic events and four bleeding events (two major and two clinically relevant non-major bleeds). The overall bleeding rate was 6.9 per 100 patient-years at risk. CONCLUSIONS There was no evidence of a significant interaction of apixaban or rivaroxaban with CNIs based on expected DOAC and CNI levels. Their use was found to be safe and effective with no VTE events and bleeding episodes similar to published trial data.
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Affiliation(s)
- Kathrine Parker
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Academic Health Science Centre, University of Manchester, Manchester, The University of Manchester, Manchester, UK
| | - Janette Chu
- Department of Pharmacy, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Muir Morton
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Shiv Bhutani
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Michael Picton
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Sandip Mitra
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK.,The University of Manchester, Division of Cardiovascular Sciences, School of Medical Sciences, Manchester, UK
| | - Jecko Thachil
- Department of Haematology, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
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Deep vein thrombosis in the setting of Klippel-Trenaunay syndrome and sirolimus treatment. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:524-528. [PMID: 34401617 PMCID: PMC8358289 DOI: 10.1016/j.jvscit.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 01/19/2023]
Abstract
Klippel-Trenaunay syndrome (KTS) is a congenital vascular disorder characterized by the triad of cutaneous capillary malformation, lymphatic and venous anomalies, and soft tissue and bone overgrowth. Sirolimus is a mechanistic target of rapamycin inhibitor used as an immunosuppressive drug. It has also been used to improve and treat vascular malformations that can predispose to intravascular coagulopathy. We have described the case of a patient with KTS receiving a therapeutic anticoagulation dose, for whom sirolimus was initiated, and who had presented with an extensive venous thromboembolism. Correlations between the use of sirolimus in patients with KTS are limited, and cautious use and monitoring could be necessary.
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Hassanein M, Abdelfattah OM, Saad AM, Isogai T, Gad MM, Ahuja KR, Ahmed T, Shekhar S, Fatica R, Poggio E, Kapadia SR. Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Kidney Transplant Recipients: A Nationwide Representative Study. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1845918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alzoubi B, Kharel A, Osman F, Aziz F, Garg N, Mohamed M, Djamali A, Mandelbrot DA, Parajuli S. Incidence, risk factors, and outcomes of post-transplant erythrocytosis after kidney transplantation. Clin Transplant 2020; 35:e14166. [PMID: 33231331 DOI: 10.1111/ctr.14166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
The incidence, risk factors, and outcomes of kidney transplant recipients (KTRs) with post-transplant erythrocytosis (PTE) in the modern era of strong, protocolized immunosuppressive management are unknown. In this study, we aim to identify the incidence and risk factors of PTE and outcomes associated with PTE. This study examined adult KTRs transplanted at our hospital between 01/2001 and 12/2016. Controls were KTRs without PTE and selected in a 1:5 ratio using incident density sampling. Patient survival, graft survival, and vascular thromboembolism (VTE) incidence were outcomes of interest. Of 4,317 kidney transplants during the study period, 214 (5%) had PTE and were compared with controls. In the multivariate analysis, recipients with older age (HR: 0.97, 95% CI 0.96-0.99, p = .001) were less likely to develop PTE, while male gender (HR: 3.2; 95% CI: 1.92-5.3, p < .001) and non-preemptive transplant (HR: 3.86, 95% CI 1.56-9.56, p = .003) were associated with increased risk of PTE. After adjustment for confounding factors, PTE was not associated with patient mortality (HR: 0.99, 95% CI 0.69-1.42, p = .97), graft failure (HR: 1.11, 95% CI 0.68-1.80, p = .69), or VTE (HR: 1.07, 95% CI 0.59-1.96, p = .81). The incidence of PTE is still substantial in this era, but with proper management PTE does not impact patient or graft survival.
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Affiliation(s)
- Beyann Alzoubi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Abish Kharel
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maha Mohamed
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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11
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Ischemic Stroke in a Young Patient with Nephrotic Syndrome and Antiphospholipid Syndrome. Case Rep Nephrol 2020; 2020:8828864. [PMID: 33294240 PMCID: PMC7718048 DOI: 10.1155/2020/8828864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 21-year-old man with underlying nephrotic syndrome (NS) secondary to minimal change disease, who developed an ischemic stroke with left hemiparesis. He received intravenous thrombolysis followed by a mechanical thrombectomy. After mechanical thrombectomy, he developed acute kidney injury which subsequently required haemodialysis. Further workup revealed that he had concomitant antiphospholipid syndrome (APS) and NS. He was started on vitamin K antagonist anticoagulant. This case report illustrates the importance of workup in identifying causes of ischemic stroke in a young patient.
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12
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Venous thromboembolism in renal transplant recipients: Results of Venous thromboEmbolism in renal Transplant Recipients- Italian Study - VETRIS. Thromb Res 2020; 198:52-54. [PMID: 33285478 DOI: 10.1016/j.thromres.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022]
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13
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Thromboprophylaxis after renal transplantation and patient risk stratification: The case of mTOR inhibitors. Thromb Res 2020; 195:100-102. [PMID: 32682002 DOI: 10.1016/j.thromres.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022]
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Aghayev A, Memon AA, Greenough PG, Nayak L, Zheng S, Siedlecki AM. Alternative Diagnostic Strategy for the Assessment and Treatment of Pulmonary Embolus: A Case Series. Clin Pract Cases Emerg Med 2020; 4:308-311. [PMID: 32926673 PMCID: PMC7434252 DOI: 10.5811/cpcem.2020.5.46517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can be used as an alternate and safe method to diagnose patients with compromised renal function who present with acute pulmonary embolus in the emergency department (ED) setting. Case Report A 62-year old man with a history of renal transplant and lymphoproliferative disease described new onset of breathlessness. His clinical symptoms were suggestive of pulmonary embolus. He underwent FeMRA in the ED to avoid exposure to intravenous iodinated contrast. FeMRA demonstrated a left main pulmonary artery embolus, which extended to the left interlobar pulmonary artery. Afterward, the patient initiated anticoagulation therapy. With preserved renal function he was able to continue his outpatient chemotherapy regimen. Conclusion This case highlights a safe imaging technique for emergency physicians to diagnose pulmonary embolus and subsequently guide anticoagulation therapy for patients in whom use of conventional contrast is contraindicated.
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Affiliation(s)
- Ayaz Aghayev
- Brigham and Women's Hospital, Department of Radiology, Boston, Massachusetts
| | - Aliza A Memon
- Brigham and Women's Hospital, Department of Internal Medicine, Boston, Massachusetts
| | - Paul Gregg Greenough
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | | | | | - Andrew M Siedlecki
- Brigham and Women's Hospital, Department of Internal Medicine, Boston, Massachusetts
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Kim MH, Jun KW, Hwang JK, Park SC, Yun SS, Moon IS, Kim JI. Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients. Ann Surg Treat Res 2020; 98:324-331. [PMID: 32528912 PMCID: PMC7263890 DOI: 10.4174/astr.2020.98.6.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/02/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Isolated distal deep vein thrombosis (IDDVT) is a localized lesion; nonetheless, the risk of proximal vein propagation makes it difficult to decide on the treatment protocol—that is, whether immediate anticoagulation after diagnosis or surveillance via serial imaging should be employed. This study aimed to investigate the appropriate treatment protocol for IDDVT in kidney transplant recipient (KTR). Methods Surveillance for venous thromboembolism (VTE) was performed using duplex ultrasonography (DUS) before transplant surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after transplant surgery. Dual mechanical prophylaxis was administered to prevent VTE. Results In total, 60 out of 829 patients (7.2%) developed VTE, with 49 cases (81.6%) of IDDVT. Among IDDVT patients, 15 patients were treated using anticoagulation-first strategy, whereas the remaining 34 patients were treated using surveillance-first strategy. No patient in either group exhibited thrombus extension into the proximal vein or recurrence within 1 year from transplant surgery. Conclusion In Korean KTR, extension of IDDVT into the proximal vein could be prevented safely and effectively by serial DUS surveillance along with the maintenance of mechanical prophylaxis. However, the patients who have high thrombus burden or are difficult to get repeated DUS require the use of anticoagulation in early stages.
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Affiliation(s)
- Mi-Hyeong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Division of Vascular and Transplant Surgery, Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeong-Kye Hwang
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Seop Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Camporese G, Bernardi D, Bernardi E, Avruscio GP, Marchini F, Bonfante L, Furian L, Neri F, Villalta S, Fabris F, Simioni P, Sartori MT. Absence of interaction between rivaroxaban, tacrolimus and everolimus in renal transplant recipients with deep vein thrombosis or atrial fibrillation. Vascul Pharmacol 2020; 130:106682. [PMID: 32438078 DOI: 10.1016/j.vph.2020.106682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/24/2020] [Accepted: 05/08/2020] [Indexed: 01/03/2023]
Abstract
No data are available on rivaroxaban use in renal transplant recipients and on its surmised interaction with immunosuppressants. The aim was to investigate potential interactions between rivaroxaban and immunosuppressants in this setting. Renal transplant recipients with a stable renal function treated with rivaroxaban and tacrolimus with or without everolimus were investigated. All drugs and creatinine concentrations were determined daily for 2 weeks after the start of anticoagulation. Blood samples were drawn at 8.00 am and 3-4 h later for trough and peak concentrations, respectively. Bleeding and thrombotic events were recorded during a minimum follow-up of 6 months. In 8 renal transplant patients, rivaroxaban levels showed a predictable pharmacokinetic trend, both at Ctrough (30-61 μg/L) and at Cpeak (143-449 μg/L), with limited variability in the 25th-75th percentile range. Tacrolimus (Ctrough 3-13 μg/L; Cpeak 3-16 μg/L), everolimus (Ctrough 3-11 μg/L; Cpeak 5-17 μg/L) and creatinine concentrations were stable as well. Immunosuppressors variability before and after rivaroxaban were 30% and 30% for tacrolimus, 27% and 29% for everolimus, respectively, as well as 14% and 3% for creatinine. For rivaroxaban monitoring, the reference change value better performed in identifying significant variations of its concentration. No patient had bleeding or thrombotic events, worsening of renal graft function, and signs of immunosuppressants toxicity during a mean follow-up of 23 (9-28) months. In conclusion, rivaroxaban does not seem to interact with tacrolimus and everolimus in renal transplant recipients. Both anticoagulant and immunosuppressive effects seem warranted, without major bleeding complications and effect on the graft function.
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Affiliation(s)
- G Camporese
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Italy.
| | - D Bernardi
- Department of Laboratory Medicine, Padova University Hospital, Italy
| | - E Bernardi
- Department of Emergency and Accident Medicine, Conegliano Hospital, Italy
| | - G P Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Italy
| | - F Marchini
- Division of Nephrology and Renal Transplantation, Padova University Hospital, Italy
| | - L Bonfante
- Division of Nephrology and Renal Transplantation, Padova University Hospital, Italy
| | - L Furian
- Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Italy
| | - F Neri
- Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Italy
| | - S Villalta
- Department of Internal Medicine, Internal Medicine AULSS2 Marca Trevigiana, Treviso Hospital, Italy
| | - F Fabris
- Department of Internal Medicine, Clinical Medicine 1, Padova University Hospital, Italy
| | - P Simioni
- Department of Internal Medicine, General Medicine Unit, Thrombotic and Haemorrhagic Disorders Unit, Padova University Hospital, Italy
| | - M T Sartori
- Department of Internal Medicine, Clinical Medicine 1, Padova University Hospital, Italy
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Beyer-Westendorf J, Marten S, Naue C, Tittl L, Sockel K, Middecke JM, Bornhäuser M. Anticoagulation with direct factor Xa inhibitors in transplant recipients: Results from the DRESDEN NOAC REGISTRY (NCT01588119). Thromb Res 2020; 191:50-55. [PMID: 32387685 DOI: 10.1016/j.thromres.2020.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany; Kings Thrombosis Service, Department of Hematology, Kings College London, UK.
| | - Sandra Marten
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Christiane Naue
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Luise Tittl
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Katja Sockel
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Jan Moritz Middecke
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Martin Bornhäuser
- Department of Medicine I, Division of Hematology, Hemostaseology and Coagulation, University Hospital "Carl Gustav Carus" Dresden, Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany
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Renal Transplantation Is Associated with Increased Complications Following Spinal Fusion Operations: Analysis of a National Database. World Neurosurg 2020; 137:e269-e277. [PMID: 32006732 DOI: 10.1016/j.wneu.2020.01.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Improved postoperative care for renal transplant recipients has advanced both duration and overall quality of life. However, degenerative spinal pathology is increasingly prevalent after transplant. Outcomes following spinal fusion among the renal transplant population in the United States are rarely addressed. METHODS The Healthcare Cost and Utilization Project National Inpatient Sample database was employed. Cases in years 2008-2014 for patients ≥18 years old receiving spinal fusion, exploration/decompression, and/or spinal revision/re-fusion surgeries were included. Cases were divided into kidney transplant recipients (KTR) and non-kidney transplant recipients. Complications, demographics, and socioeconomic outcomes were compared between cohorts. RESULTS Of 579,726 patients who met inclusion criteria, 685 (0.1%) were KTRs. The KTR population was older and included more men compared with the non-kidney transplant recipient population (60.1 years vs. 56.6 years, P < 0.001; 58% male vs. 45.5% male, P < 0.001). KTRs experienced higher total complication rates (29.8% vs. 18.9%, P < 0.001). Prevalence of acute posthemorrhagic anemia and need for transfusion was markedly higher for KTRs (15.8% vs. 9.1%, P < 0.001; 13.6% vs. 6.2%, P < 0.001). Multivariate analysis revealed longer length of stay (median 1.23 days, interquartile range 0.94-1.53, P < 0.001), lower routine discharge (odds ratio = 0.57, 95% confidence interval 0.48-0.69, P < 0.001), and higher discharge to alternative care facilities (odds ratio = 1.91, 95% confidence interval 1.57-2.33, P < 0.001) for KTRs. The inpatient course for KTRs undergoing spinal operations was significantly costlier ($87,445 vs. $71,589, P < 0.001). CONCLUSIONS History of renal transplant was associated with increased inpatient medical and socioeconomic complications following spinal fusion. Physicians and patients must understand and respect the potentially increased perioperative challenges facing KTRs.
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19
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Scheetz S, Pandey D, Pesavento TE, Singh P. Chronic mesenteric ischaemia masked by candida esophagitis in a renal transplant patient. BMJ Case Rep 2019; 12:12/12/e232938. [PMID: 31892626 DOI: 10.1136/bcr-2019-232938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic mesenteric ischaemia is a severe disease that is often missed due to its non-specific presentation. Immunosuppressed patients are at risk for infectious gastrointestinal disease, which may further obscure the diagnosis of chronic mesenteric ischaemia. In this case, a patient's symptoms and diagnostic workup were consistent with candida esophagitis. Worsening leukocytosis despite treatment, however, prompted re-evaluation ultimately revealing a superior mesenteric artery thrombus causing mesenteric ischaemia. The patient required urgent surgical intervention for the management of his disease.
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Affiliation(s)
- Seth Scheetz
- Comprehensive Transplant Center, Ohio State University, Columbus, Ohio, USA
| | - Deepali Pandey
- Montefiore Medical Center/Albert Einstein College of Medicine at MJHS, New York, New York, USA
| | - Todd E Pesavento
- Comprehensive Transplant Center, Ohio State University, Columbus, Ohio, USA
| | - Priyamvada Singh
- Comprehensive Transplant Center, Ohio State University, Columbus, Ohio, USA
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20
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Nieuwenhuijs-Moeke GJ, van den Berg TAJ, Bakker SJL, van den Heuvel MC, Struys MMRF, Lisman T, Pol RA. Preemptively and non-preemptively transplanted patients show a comparable hypercoagulable state prior to kidney transplantation compared to living kidney donors. PLoS One 2018; 13:e0200537. [PMID: 30011293 PMCID: PMC6047796 DOI: 10.1371/journal.pone.0200537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/26/2018] [Indexed: 12/14/2022] Open
Abstract
To prevent renal graft thrombosis in kidney transplantation, centres use different perioperative anticoagulant strategies, based on various risk factors. In our centre, patients transplanted preemptively are considered at increased risk of renal graft thrombosis compared to patients who are dialysis-dependent at time of transplantation. Therefore these patients are given a single dose of 5000 IU unfractionated heparin intraoperatively before clamping of the vessels. We questioned whether there is a difference in haemostatic state between preemptively and non-preemptively transplanted patients and whether the distinction in intraoperative heparin administration used in our center is justified. For this analysis, citrate samples of patients participating in the VAPOR-1 trial were used and several haemostatic and fibrinolytic parameters were measured in 29 preemptively and 28 non-preemptively transplanted patients and compared to 37 living kidney donors. Sample points were: induction anaesthesia (T1), 5 minutes after reperfusion (T2) and 2 hours postoperative (T3). At T1, recipient groups showed comparable elevated levels of platelet factor 4 (PF4, indicating platelet activation), prothrombin fragment F1+2 and D-dimer (indicating coagulation activation) and Von Willebrand Factor (indicating endothelial activation) compared to the donors. The Clot Lysis Time (CLT, a measure of fibrinolytic potential) was prolonged in both recipient groups compared to the donors. At T3, F1+2, PF4 and CLT were higher in non-preemptively transplanted recipients compared to preemptively transplanted recipients. Compared to donors, non-preemptive recipients showed a prolonged CLT, but comparable levels of PF4 and D-dimer. In conclusion pre-transplantation, preemptively and non-preemptively transplanted patients show a comparable enhanced haemostatic state. A distinction in intraoperative heparin administration between preemptive and non-preemptive transplantation does not seem justified.
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Affiliation(s)
- Gertrude J. Nieuwenhuijs-Moeke
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- * E-mail:
| | - Tamar A. J. van den Berg
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Stephan J. L. Bakker
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marius C. van den Heuvel
- Department of Pathology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Michel M. R. F. Struys
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Anesthesia, Ghent University, Ghent, Belgium
| | - Ton Lisman
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Robert A. Pol
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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21
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Cicora F, Petroni J, Roberti J. Prophylaxis of Pulmonary Embolism in Kidney Transplant Recipients. Curr Urol Rep 2018; 19:17. [DOI: 10.1007/s11934-018-0759-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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22
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Gauthier M, Canoui-Poitrine F, Guéry E, Desvaux D, Hue S, Canaud G, Stehle T, Lang P, Kofman T, Grimbert P, Matignon M. Anticardiolipin antibodies and 12-month graft function in kidney transplant recipients: a prognosis cohort survey. Nephrol Dial Transplant 2018; 33:709-716. [DOI: 10.1093/ndt/gfx353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/24/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marion Gauthier
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
| | - Florence Canoui-Poitrine
- Department of Public Health, Groupe Hospitalier Henri-Mondor/Albert Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) A-TVB, IMRB (Institut Mondor de Recherche Biomédicale)- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est-Créteil, UPEC, Créteil, France
| | - Esther Guéry
- Department of Public Health, Groupe Hospitalier Henri-Mondor/Albert Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
| | - Dominique Desvaux
- Pathology Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
| | - Sophie Hue
- Immunology Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- INSERM U955, team 16, IMRB Créteil, Créteil, France
- Faculté de Médecine, Vaccine Research Institute (VRI), Université Paris Est Créteil, Créteil, France
| | - Guillaume Canaud
- INSERM U1151, Institut Necker Enfants Malades, Hôpital Necker-Enfants Malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
- Service de Néphrologie Transplantation Adultes, Hôpital Necker-Enfants Malades, Paris, France
| | - Thomas Stehle
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil, (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
| | - Philippe Lang
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil, (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
| | - Tomek Kofman
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil, (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
| | - Philippe Grimbert
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil, (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), CIC-BT 504, Créteil, France
| | - Marie Matignon
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France
- DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil, (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
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Lam NN, Garg AX, Knoll GA, Kim SJ, Lentine KL, McArthur E, Naylor KL, Bota SE, Sood MM. Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients. Am J Nephrol 2017; 46:343-354. [PMID: 29024935 DOI: 10.1159/000480304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/10/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The implications of venous thromboembolism (VTE) for morbidity and mortality in kidney transplant recipients are not well described. METHODS We conducted a retrospective study using linked healthcare databases in Ontario, Canada to determine the risk and complications of VTE in kidney transplant recipients from 2003 to 2013. We compared the incidence rate of VTE in recipients (n = 4,343) and a matched (1:4) sample of the general population (n = 17,372). For recipients with evidence of a VTE posttransplant, we compared adverse clinical outcomes (death, graft loss) to matched (1:2) recipients without evidence of a VTE posttransplant. RESULTS During a median follow-up of 5.2 years, 388 (8.9%) recipients developed a VTE compared to 254 (1.5%) in the matched general population (16.3 vs. 2.4 events per 1,000 person-years; hazard ratio [HR] 7.1, 95% CI 6.0-8.4; p < 0.0001). Recipients who experienced a posttransplant VTE had a higher risk of death (28.5 vs. 11.2%; HR 4.1, 95% CI 2.9-5.8; p < 0.0001) and death-censored graft loss (13.1 vs. 7.5%; HR 2.3, 95% CI 1.4-3.6; p = 0.0006) compared to matched recipients who did not experience a posttransplant VTE. CONCLUSIONS Kidney transplant recipients have a sevenfold higher risk of VTE compared to the general population with VTE conferring an increased risk of death and graft loss.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
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24
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Yanik MV, Irvin MR, Beasley TM, Jacobson PA, Julian BA, Limdi NA. Influence of Kidney Transplant Status on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage. Pharmacotherapy 2017; 37:1366-1373. [PMID: 28949423 DOI: 10.1002/phar.2032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY DESIGN To assess whether warfarin dose requirement, anticoagulation control, and risk of hemorrhage differ in kidney transplant recipients (KTRs) compared with patients without kidney transplants (non-KTRs). DESIGN Analysis of data from the Warfarin Pharmacogenetics Cohort, a prospective cohort of first-time warfarin users followed at two anticoagulation clinics. SETTING Two outpatient anticoagulation clinics at two large, academic, tertiary care hospitals. PATIENTS Adults aged 20 years or older starting warfarin for anticoagulation with a therapeutic international normalized ratio (INR) goal of 2-3 who were KTRs (n=65) or non-KTRs (n=1630). MEASUREMENTS AND MAIN RESULTS Warfarin dose requirement, anticoagulation control, and risk of hemorrhage were assessed in each group. KTRs required an approximately 20% lower warfarin dose (4.7 vs 5.6 mg/day, p=0.0005) compared with non-KTRs. Genetic variants had similar effects on dose in both groups. Mean percentage of time in therapeutic range (PTTR) was similar among KTRs and non-KTRs. Although the proportion of patients achieving good anticoagulation control (PTTR ≥ 60%) was low in both groups, it was similar among KTRs and non-KTRs. KTRs had a higher risk of major hemorrhage (hazard ratio 2.1, p=0.0081), but this difference was not statistically significant after controlling for kidney function, clinical, and genetic factors. CONCLUSION KTRs initiating warfarin require lower doses and closer monitoring to optimize anticoagulation therapy. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Megan V Yanik
- Division of Nephrology, Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - T Mark Beasley
- Biostatistics, Section on Statistical Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamala A Jacobson
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
| | - Bruce A Julian
- Division of Nephrology, Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita A Limdi
- Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Amaral C, Guimarães Pereira L, Moreto A, Sá AC, Azevedo A. The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty. Rev Port Cardiol 2017; 36:609-616. [PMID: 28867599 DOI: 10.1016/j.repc.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 11/11/2016] [Accepted: 11/25/2016] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. METHODS We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. RESULTS Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). CONCLUSIONS The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%.
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Affiliation(s)
- Cristina Amaral
- Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal.
| | | | - Ana Moreto
- Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Carolina Sá
- Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Azevedo
- Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Centro de Epidemiologia Hospitalar, Centro Hospitalar de São João, Porto, Portugal
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The postoperative venous thromboembolism (TREVO) study – Risk and case mortality by surgical specialty. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Antiphospholipid Syndrome: Role of Vascular Endothelial Cells and Implications for Risk Stratification and Targeted Therapeutics. J Am Coll Cardiol 2017; 69:2317-2330. [PMID: 28473138 DOI: 10.1016/j.jacc.2017.02.058] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by venous thromboembolism, arterial thrombosis, and obstetric morbidities in the setting of persistently positive levels of antiphospholipid antibodies measured on 2 different occasions 12 weeks apart. Patients with APS are at increased risk for accelerated atherosclerosis, myocardial infarction, stroke, and valvular heart disease. Vascular endothelial cell dysfunction mediated by antiphospholipid antibodies and subsequent complement system activation play a cardinal role in APS pathogenesis. Improved understanding of their pathogenic function could help in the risk stratification of patients with APS and provide new molecular therapeutic targets.
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Castillo-Eraso L, Melilli E, Cabre C, Manonelles A, Landeyro J, Bestard O, Cruzado JM, Martinez-Vea A. Posttransplant Lymphoproliferative Disease and Inhibitors of Mammalian Target of Rapamycin: When a Quick Look Back Can Change the Perspective. EXP CLIN TRANSPLANT 2017; 16:761-764. [PMID: 28666406 DOI: 10.6002/ect.2016.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posttransplant lymphoproliferative disease represents a heterogeneous group of diseases characterized by uncontrolled proliferation of lymphocytes, favored by immunosuppression. Several risk factors for its development have been described, with Epstein-Barr virus infection being a main cause of early-onset forms and chronic antigen stimulation of donors and/or accumulated immunosuppression as key factors of later forms of lymphocyte transformation. The present clinical case presents a patient diagnosed with posttransplant lymphoproliferative disease 3 years after renal transplant who had a potentially lethal complication related to conversion to inhibitors of mammalian target of rapamycin. Because clinical studies that establish the most suitable treatment are lacking, it is recommended to identify the strategy, defining possible risks versus benefits of conversion to inhibitors of mammalian target of rapamycin in cases of posttransplant lymphoproliferative disease, and to maintain a high level of surveillance in case of possible secondary effects that can be verified after their introduction.
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Symptomatic Venous Thromboembolism and Major Bleeding After Renal Transplantation: Should We Use Pharmacologic Thromboprophylaxis? Transplant Proc 2017; 48:2773-2778. [PMID: 27788816 DOI: 10.1016/j.transproceed.2016.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major health issue that may result in complications such as post-thrombotic syndrome, pulmonary hypertension, and death. Appropriate thromboprophylaxis in individuals undergoing kidney transplantation remains unclear. The aim of this study was to determine the prevalence of symptomatic VTE and major bleeding within 90 days after renal transplantation (RT). METHODS This was a retrospective study on consecutive patients undergoing RT at Hospital Privado Córdoba, Argentina, from January 1, 2006, to December 31, 2013. Exclusion criteria were age <18 years and combined organ transplantation. Pharmacologic or mechanical thromboprophylaxis was not used routinely. Symptomatic VTE and major bleeding were documented. RESULTS A total of 511 RTs were performed; 62 patients received combined organ transplantation, and 8 patients (1.5%) were lost to follow-up. Overall, follow-up was completed on 441 patients, 4 (0.9%) of whom developed deep venous thrombosis and 14 (3%) of whom died. The most frequent causes of death were septic shock and severe hemorrhage. Duration of surgery >4 hours (P = .006) and a history of VTE (P < .001) were associated with VTE. Twenty-three patients (5.2%) had major bleeding, 2 (0.4%) died from bleeding complications, and 17 (3.85%) required a reoperation to control bleeding. CONCLUSIONS This study shows a low prevalence of symptomatic VTE in patients undergoing RT despite not having used thromboprophylaxis routinely. Major bleeding was significant, and despite the high risk of VTE assigned by the Caprini score, which suggests pharmacologic prophylaxis, our data raise questions about the appropriate prophylaxis for these patients.
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Ahn S, Kim MH, Jun KW, Hwang JK, Park SC, Moon IS, Kim JI. The incidence and risk factors for deep vein thrombosis after kidney transplantation in Korea: single-center experience. Clin Transplant 2015; 29:1181-6. [DOI: 10.1111/ctr.12648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Sanghyun Ahn
- Department of Surgery; Yeouido St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Mi-Hyeong Kim
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Kang-Woong Jun
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jeong-Kye Hwang
- Department of Surgery; Daejeon St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Soon-Chul Park
- Department of Surgery; Uijeongbu St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Sung Moon
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Ji-Iil Kim
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
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Nweke C, Martin E, Gehr T, Brophy D, Carl D. Differences in coagulation in clotting of vascular access in hemodialysis patients. Hemodial Int 2014; 19:323-9. [PMID: 25413181 DOI: 10.1111/hdi.12241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Arteriovenous graft (AVG) thrombosis is a frequent cause of graft failure. We evaluated coagulation protein concentrations, platelet function, and viscoelasticity factors in 20 hemodialysis (HD) patients with AVGs. The goal was to determine whether significant differences in protein concentrations, platelet function, and viscoelasticity factors exist among dialysis patients requiring frequent AVG declot procedures vs. those who do not. Twenty HD patients were enrolled: 10 frequent clotters (>3 declots in the previous year) and 10 were nonclotters. Patients on antiplatelets or chronic anticoagulation were excluded. Laboratories were drawn pretreatment and heparinase was added to counteract any potential heparin effect. Coagulation protein concentrations including tissue factor (TF), thrombin/antithrombin III complex (TAT), and prothrombin fragment 1 + 2 (F(1+2)) were assayed. The time to clot onset was measured by force onset time (FOT). Platelet contractile force (PCF) measured the force produced by platelets during clot retraction, whereas clot rigidity was measured as clot elastic modulus (CEM). FOT, CEM, and PCF were measured by Hemodyne. Both groups had upregulation of the TF pathway, as TF, TAT, and F(1+2) levels were similarly increased over baseline levels. Hemodialysis patients with frequent AVG clotting had higher levels of both PCF and CEM compared with nonclotters. Additionally, the frequent clotters had a lower FOT relative to nonclotters, although both were considered in the normal range. Our study suggests that HD patients with recurrent AVG thrombotic events form clots with higher tensile strength compared with HD patients without recurrent graft thrombosis.
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Affiliation(s)
- Chinedu Nweke
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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