Evaluation of the coagulation and inflammatory responses in solid organ transplant recipients and donors

Levitsky, Josh; Freifeld, Alison G.; Lyden, Elizabeth; Stoner, Julie A.; Florescu, Diana F.; Langnas, Alan Norman; Stevens, R. Brian; Hardiman, Penny; Hill, Lisa; Kalil, André C.

doi:10.1111/j.1399-0012.2009.01038.x

Cited by 15 publications

(8 citation statements)

References 42 publications

(46 reference statements)

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“…Low plasma levels of protein C recipient was associated, in this work, with liver disease relapse (Additional File 2, Table S2), and this fact could be a consequence of disbalance of coagulation factors in terminal cirrhosis [28]. A previous paper had shown that PC was decreased at day 7 (p = 0.04) and day 30 (p = 0.009) in DDLT and DDRT/LRT groups with complications, respectively [29]. Nevertheless, high plasma fibrinogen levels are not a consequence of liver function alteration, and could be an important pro-thrombotic factor in development graft thrombosis that has not been previously described.…”

Section: Discussionmentioning

confidence: 58%

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

et al. 2011

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BackgroundVascular complications, such as HAT, are an important cause of graft loss and recipient mortality. We aimed to characterize post-transplant thrombotic events in a cohort of liver transplant recipients, and identify independent risk factors for these complications.MethodsWe conducted a thrombophilic study of 293 orthotopic liver transplants performed in the Digestive Surgery Department of the 12 de Octubre Hospital (Madrid, Spain) between January 2001 and December 2006.ResultsThe most frequent post-transplant thrombotic events were HAT (9%) and PVT (1.7%). The one variable associated with post-transplant thrombotic event was a high fibrinogen level in the global cohort of liver transplantation. But toxicity as event post-OLT has been associated with post-transplant thrombotic event in the retrospective group and high fibrinogen level and low protein C levels were associated post-transplant thrombotic event in the prospective group. Liver disease relapse (HR 6.609, p < 0.001), high levels of FVIII (HR 1.008, p = 0.019)) and low levels of antithrombin (HR 0.946, p < 0.001) were associated with poor overall survival (OS).In conclusion, high fibrinogen and decreased protein C levels were associated with allograft thrombosis. Further studies are required in order to assess the clinical relevance of these parameters in prospective studies and to study the effect of anticoagulation prophylaxis in this group of risk.

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Section: Discussionmentioning

confidence: 58%

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

et al. 2011

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“…Although elevated C-reactive protein is associated with increased cardiovascular events, it has only been studied post-operatively in the ESLD population (31). C-reactive protein appears to peak and slowly fall within 1 week after LT, and delayed elevations may indicate inflammatory complications such as post-operative infection or rejection (32).…”

Section: Coronary Artery Diseasementioning

confidence: 97%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

228

174

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Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.

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“…The technology employed for biopsy assessment and the resulting diagnostic classification did however not always keep pace with the rapidly evolving knowledge about the mechanisms of rejection [ 2 ]. Therefore, new biomarkers for early predicting renal graft dysfunctions are clearly needed [ 4 , 8 , 9 ]. In this regard, it is well known that the activation of blood coagulation or suppression of fibrinolysis plays a role in the progression of atherosclerosis in renal transplanted patients and it seems to be the major cause of mortality after transplant.…”

Section: Discussionmentioning

confidence: 99%

“…Acute rejection has been associated with activation of inflammatory factors and coagulation cascade during the first three months after renal transplant. Acute rejection may result in graft loss, increased risk of chronic allograft dysfunction, and suboptimal long-term outcome [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hemostatic biomarkers have been suggested to evaluate the thrombotic status and rejection risk in renal transplanted patients, mainly D-Dimer (D-Di) levels, which inform about fibrin formation and degradation [ 8 , 10 ]. The aim of this study was to evaluate D-DI, TM, VWF, and ADAMTS13 plasma levels in Brazilian renal transplanted patients and investigate the association of these parameters and creatinine plasma levels, eGFR, and time (months) after transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Hemostatic Parameters according to Renal Function and Time after Transplantation in Brazilian Renal Transplanted Patients

et al. 2015

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Kidney transplantation is the key for patients with end-stage renal disease, improving quality of life and longer survival. However, kidney transplant triggers an intense inflammatory response and alters the hemostatic system, but the pathophysiological mechanisms of these changes are not completely understood. The aim of this cross-sectional cohort study was to investigate hemostatic biomarkers in Brazilian renal transplanted patients according to renal function and time after transplantation. A total of 159 renal transplanted patients were enrolled and D-Dimer (D-Di), Thrombomodulin (TM), von Willebrand Factor (VWF), and ADAMTS13 plasma levels were assessed by ELISA. An increase of D-Di was observed in patients with higher levels of creatinine. ADAMTS13 levels were associated with creatinine plasma levels and D-Di levels with Glomerular Filtration Rate. These results suggested that D-Di and ADAMTS13 can be promising markers to estimate renal function. ADAMTS13 should be investigated throughout the posttransplant time to clarify the participation of this enzyme in glomerular filtration and acceptance or rejection of the graft in Brazilian transplanted patients.

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Evaluation of the coagulation and inflammatory responses in solid organ transplant recipients and donors

Cited by 15 publications

References 42 publications

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Hemostatic Parameters according to Renal Function and Time after Transplantation in Brazilian Renal Transplanted Patients

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