Do we need screening for thrombophilia prior to kidney transplantation?

Andrassy, Joachim

doi:10.1093/ndt/gfh1045

Cited by 39 publications

(34 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 Transplant renal artery/vein thrombosis generally occurs during the first 2 postoperative weeks and is reported in up to 6% of kidney transplants. 13,14 In pediatric kidney transplant, graft loss due to thrombosis is a major problem. 15 According to the data from the North American Pediatric Renal Transplant Cooperative Study, vascular thrombosis accounts for 11.6% of graft losses in pediatric renal transplant.…”

Section: Discussionmentioning

confidence: 99%

“…13 Several investigators have reported a dramatic increase in the incidence of renovascular thrombosis among cyclosporine-treated renal transplant recipients when compared with recipients treated with prednisone and azathioprine only. [23][24][25] Interestingly, a prospective multicenter study showed no significant difference regarding the occurrence of renovascular thrombosis under cyclosporine versus azathioprine.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant

Sakallı

Baskın²,

Bayrakçı³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

artIClE AbstractObjectives: We sought to evaluate the importance of mean platelet volume as a marker to follow-up, the tendency for hemorrhagic diatheses, and/or thrombotic complications in patients before and after renal transplant. Materials and Methods: Thirty-four patients (aged, 5 to 18 y) were included. Demographics of the patients, cause of chronic renal failure, dialysis modality, duration of dialysis, arterio-venous fistula thrombosis, and posttransplant immunosuppressive regimens were recorded and laboratory variables were evaluated. Results: At the end of the first posttransplant month, mean platelet volume level was decreased significantly when compared with pretransplant levels (8.3 ± 1.5 vs 7.7 ± 0.9; P = .04). A significant increase was observed in platelet levels during posttransplant measures (273.750 ± 97.700 vs 318.740 ± 84.586; P = .02). Prothrombin time and partial thromboplastin time levels did not differ before and after transplant. None of the patients had any thrombotic events and/or renal allograft loss. A negative correlation was observed between mean platelet volume and C-reactive protein (r=-0.53). Mean platelet volume level was not found to be related to the cause of renal failure, pretransplant dialysis modality, or posttransplant immunosuppressive regimens. Conclusions:Platelet numbers increased and mean platelet volume decreased after pediatric renal transplant, but the potential for increased thrombosis was not observed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant

Sakallı

Baskın²,

Bayrakçı³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

show abstract

“…When the disorder is diagnosed in pretransplant assessment, anticoagulation therapy must be initiated immediately. 10,11 Low molecular weight heparin, unfractionated heparin, or warfarin may be used in doses that provide therapeutic effect. Because of renal deficiency, titration and individualization of doses are necessary to achieve target therapeutic levels, which differ depending on the anticoagulant agent used.…”

Section: Discussionmentioning

confidence: 99%

“…Because of renal deficiency, titration and individualization of doses are necessary to achieve target therapeutic levels, which differ depending on the anticoagulant agent used. 10,11 Repeated measurements either of anti Xa levels or aPTT or INR, and hence dose titration, are necessary not only to prevent thrombotic events perioperatively but also, to prevent postoperative hemorrhage in recipients with thrombophilic disorders. 12,13 In children with thrombophilia the incidence of graft thrombosis is higher than adults considering the fact that renal transplant in children with endstage renal disease has already 11.6% risk of acute graft thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Florou

Koukoulaki²,

Theodoros³

et al. 2017

Exp Clin Transplant

View full text Add to dashboard Cite

Thrombophilia due to activated protein C resistance (Leiden mutation) is the most common inherited thrombophilic disorder with 5% incidence in whites. Renal transplant of these patients entails a risk of vascular thrombosis soon after the transplant; and acute rejection episodes and graft loss within the first year. We present a case of a successful living-related renal transplant in man with a recent history of repeat episodes of vascular access thrombosis attributed to inherited thrombophilia (heterozygosity for factor V mutation Q506 and homozygosity for mutation T677 for methylenetetrahydrofolate reductase). Transplant recipient was administered anticoagulation therapy with low molecular weight heparin pre-and postoperatively. No thrombotic or hemorrhagic events occurred posttransplant. A high suspicion of thrombophilic disorders in patients with end-stage renal disease with vascular access thrombotic events should be screened further to prevent failure of a subsequent renal transplant. Inherited thrombophilic disorders may not exclude living-related kidney transplant provided that anticoagulation therapy is administered perioperatively.

show abstract

“…In one study of 502 end-stage renal disease patients 11 of 23 patients identified with APS underwent transplant. 47,48 All 7 who did not receive peri-operative anticoagulation lost their grafts within 1 week of transplant due to thrombosis, whereas 3 of 4 who received prophylactic anticoagulation maintained long-term graft function. Importantly, none of the 37 patients with only serologic evidence of antiphospholipid antibodies but no prior history of clinical thrombosis received anticoagulation.…”

Section: Organ Transplantationmentioning

confidence: 99%

Management of Hereditary Hypercoagulable Disorders

Bockenstedt¹

2006

Hematology

View full text Add to dashboard Cite

The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome. Initial DecisionsThe clinical management of individuals with hereditary hypercoagulable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism (VTE) to a more intricate, individualized risk-benefit analysis as the complexity of interactions of acquired and hereditary factors that determine the predilection to thrombosis are now recognized. Important behind stratifying risk of recurrent events is the necessity of correctly identifying hereditary thrombophilic disorders, especially in circumstances in which laboratory results, e.g., mildly low antithrombin III (ATIII) or protein S levels, may be more indicative of a temporary acquired deficiency. The relevance of thrombophilic testing is debated, but most clinicians agree that prothrombotic assessment should be considered in individuals with unprovoked thrombosis at age less than 40 years, individuals who have had thrombosis at an unusual anatomic site or who have had repeated thromboses, or when the family history suggests multiple affected individuals. For review of the laboratory assessment of thrombophilia see references [1][2][3] . The following discussion is not meant to be comprehensive, but serves to highlight a few of the clinical management decisions important in the care of the thrombophilic patient. Therapeutic considerations involving individuals with antiphospholipid syndrome (APS) will be included where pertinent. Duration of anticoagulant therapyThe decision to extend therapy beyond 6-12 months after an incident thrombotic event must be made on an individual basis. Patients with a transient risk factor such as oral contraceptive use, postsurgical state or limb immobilization have a low risk of recurrence of thrombosis once anticoagulation has been completed. (For review see 4,5 .) Identifying the individual with moderate to high risk of recurrent thrombosis is important to prevent the unnecessary risk of hemorrhage from long-term anticoagulation. From studies of patients with a first VTE (both with and without diagnosed hereditary thrombophilia), one third of patients with unprovoked VTE will have a reoccurrence over the next 10 years and 6% of patients with VTE develop postphlebitic syndrom...

show abstract

Do we need screening for thrombophilia prior to kidney transplantation?

Cited by 39 publications

References 39 publications

Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant

Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant

Untitled

Management of Hereditary Hypercoagulable Disorders

Contact Info

Product

Resources

About