Necessity of Routine Postoperative Heparinization in Non-Risky Live-Donor Renal Transplantation: Results of a Prospective Randomized Trial

Osman, Yasser; Kamal, Mohamed M.; Soliman, Shady; Sheashaa, Hussein; Shokeir, Ahmed A.; El-Dein, Ahmed B. Shehab

doi:10.1016/j.urology.2006.12.017

Cited by 38 publications

(41 citation statements)

References 17 publications

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“…In our institute we have performed a prospective randomized study including 75 patients, randomized to one of three arms; one group received no anticoagulants, one received conventional unfractionated heparin, and the third received low molecular weight heparin in low-risk renal transplants. We concluded that postoperative heparin administration in low-risk live-donor renal transplantation is associated with a significant decrease in haemoglobin level, as well as prolonged and excessive lymph drainage, with no improvement in graft outcome, and should not be routine in low-risk live-donor renal transplantation [18]. An extensive review of previous reports failed to find one study discussing the role of heparin administration in renal transplants with MGA.…”

Section: Discussionmentioning

confidence: 91%

Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients

Soliman

Shokeir

Kamal

et al. 2011

Arab Journal of Urology

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PurposeTo analyse the long-term outcome in relation to multiple graft arteries (MGA) in live-donor renal transplantation, and assess its effect on graft and patient survival.Patients and methodsBetween March 1976 and November 2009, a total of 2100 live-donor renal transplants were carried out at our centre. Patients were stratified according to the number of graft arteries into two groups, i.e. MGA (two or more arteries; 237 patients) and single-graft artery (SGA; 1863 patients). Variables assessed included patient demographics, site of vascular anastomosis, ischaemia time, onset of diuresis, delayed graft function, acute tubular necrosis (ATN), acute rejection, vascular and urological complications. Moreover, long-term patient and graft survival were compared among both groups. Patients were followed up for a mean (SD) of 112 (63) months.ResultsGrafts with MGA were associated with a prolonged ischaemia time (P = 0.001) and ATN (P = 0.005). Vascular thrombosis (arterial and venous) had a higher incidence in MGA (2.5%) than SGA (0.6%) (P = 0.01). Both groups were not significantly different for the onset of diuresis, acute rejection and urological complications (P = 0.16, 0.23 and 0.85, respectively). Graft and patient survival were comparable in both groups. The mean (SD) 1-, 5-, 10- and 20-year graft survival rates (%) for MGA were 96.1 (1.26), 86.6 (2.39), 61.3 (4.42) and 33.8 (7.23), and 97.5 (0.36), 86.8 (0.84), 66.0 (1.35) and 37.3 (2.76) for SGA (P = 0.54).ConclusionsAlthough there was a higher incidence of prolonged ischaemia time, ATN and vascular thrombosis in live-donor renal transplants with MGA, it did not adversely affect patient or graft survival. The early, intermediate- and long-term follow-up showed an outcome comparable to that in patients with SGA.

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Section: Discussionmentioning

confidence: 91%

Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients

Soliman

Shokeir

Kamal

et al. 2011

Arab Journal of Urology

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“…Previous reports are limited to single case reports or case series, medication- or cause-specific hemorrhagic complications, or peri-/postoperative-related hemorrhage [6,9,10,11,12,27,28,29,30]. In contrast, our study provides a cumulative picture of the impact of hemorrhage and its associated hospitalizations in kidney transplant recipients.…”

Section: Discussionmentioning

confidence: 95%

“…In kidney transplant recipients, the incidence of hemorrhage remains unknown. Previous studies have only been case reports or case series, limited to surgical or medication-related hemorrhage, with a relatively short duration of follow-up [6,7,8,9,10,11,12]. It is also unknown whether factors associated with hemorrhage in the general population, such as advancing age, or factors associated with increased complications in transplant recipients, such as donor kidney type, are associated with increased risk [13].…”

Section: Introductionmentioning

confidence: 99%

Risk of Major Hemorrhage after Kidney Transplantation

Sood¹,

Ax²,

Se³

et al. 2015

Am J Nephrol

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Background: Major hemorrhagic events are associated with significant morbidity and mortality. We examined the three-year cumulative incidence of hospitalization with major nontraumatic hemorrhage after kidney transplantation. Methods: We performed a retrospective cohort study using healthcare administrative data of all adult-incident kidney-only transplantation recipients in Ontario, Canada from 1994 to 2009. We calculated the three-year cumulative incidence, event rate, and incident rate ratio of hospitalization with major hemorrhage, its subtypes and those undergoing a hemorrhage-related procedure. Results were stratified by patient age and donor type and compared to a random and propensity-score matched sample from the general population. Results: Among 4,958 kidney transplant recipients, the three-year cumulative incidence of hospitalization with nontraumatic major hemorrhage was 3.5% (95% confidence interval [CI] 3.0-4.1%, 12.7 events per 1,000 patient-years) compared to 0.4% (95% CI 0.4-0.5%) in the general population (RR = 8.2, 95% CI 6.9-9.7). The crude risk of hemorrhage was 3-9-fold higher in all subtypes (upper/lower gastrointestinal, intra-cranial) and 15-fold higher for gastrointestinal endoscopic procedures compared to the random sample from the general population. After propensity score matching, the relative risk for major hemorrhage and its subtypes attenuated but remained elevated. The cumulative incidence of hemorrhage was higher for older individuals and those with a deceased donor kidney. Conclusion: Kidney transplantation recipients have a higher risk of hospitalization with hemorrhage compared to the general population, with about 1 in 30 recipients experiencing a major hemorrhage in the three years following transplant.

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“…[69]. There are neither evidencebased nor consensus guidelines on the use of immediate postoperative thromboprophylaxis to prevent renal allograft vascular thrombosis because of the lack of powerful studies [70] and contradictory results of prospective studies [71][72][73].…”

Section: Discussionmentioning

confidence: 99%

Safety of dual kidney transplantation compared to single kidney transplantation from expanded criteria donors: a single center cohort study of 39 recipients

Mendel¹,

Albano²,

Bentellis³

et al. 2018

Transpl Int

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Our objective was to compare the outcomes of dual kidney transplanataion (DKT) to single kidney transplantation (SKT) performed with grafts from expanded criteria donors (ECD) in recipients ≥65 years, focusing on surgical complications. All kidney transplantations (KT) performed between 2006 and 2014 in our institution were analysed. DKT was indicated according to the criteria of the French national Agence de la Biomedecine. Thirty-nine DKT and 155 SKT were included, with a median follow-up of 36 and 26.5 months, respectively. The rate of early surgical revisions was not significantly higher after DKT (23.1% vs 15.5% (P = 0.2593)) but more venous graft thromboses (12.8% vs 3.2% (P = 0.02)) were reported. The glomerular filtration rate (GFR) 24 months after KT was significantly higher after DKT (45.0 ± 16.3 vs 39.8 ± 13.8 ml/min/1.73m ; P = 0.04) and allowed shorter waiting time without a significant increased risk of surgical revision, excepted for venous graft thrombosis, more frequent after DKT. Graft survivals were not significantly different and GFR was higher after DKT. DKT seems to remain an appropriate strategy to address the growing graft shortage in elderly patients.

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Necessity of Routine Postoperative Heparinization in Non-Risky Live-Donor Renal Transplantation: Results of a Prospective Randomized Trial

Cited by 38 publications

References 17 publications

Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients

Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients

Risk of Major Hemorrhage after Kidney Transplantation

Safety of dual kidney transplantation compared to single kidney transplantation from expanded criteria donors: a single center cohort study of 39 recipients

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