Renal transplant recipients are at high risk for both symptomatic and asymptomatic deep vein thrombosis

Abstract

Summary. Background: Venous thromboembolism (VTE) is one of the thrombotic complications that can occur in patients receiving renal transplantation (RT). The prevalence of VTE in RT patients is, however, undefined. Objectives: To evaluate the rate of a first episode of VTE in a series of 538 consecutive RT recipients admitted to our institution, the timing of occurrence of the thromboembolic events after transplantation, and the rate of recurrence after thromboprophylaxis withdrawal. Risk factors for recurrence were also evaluated, particularly in relation to the type of the first event (symptomatic or asymptomatic). Results: During follow-up, 47 of 518 patients (28 males, 19 females; 9.1%) developed a first episode of VTE at a median time of 17 months (range 1-165 months) after kidney transplantation. Cancer was associated with the occurrence of VTE (odds ratio 4.8). Seventeen of 43 patients (39.5%) with deep vein thrombosis were asymptomatic and the diagnosis was made during routine ultrasound examination. Twenty-two patients (46.8%) experienced a recurrence of VTE. A relevant rate of recurrence was documented amongst patients with a first episode of both symptomatic (53%) and asymptomatic (23.5%) VTE. Conclusion: This study confirms that RT patients are at high risk of symptomatic and asymptomatic VTE and that this risk persists even after several years. Patients who experience VTE are at high risk of recurrence after thromboprophylaxis withdrawal.

Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients

“…Renal- and transplant-specific risk factors, such as reduced renal function (compared to the general population), erythrocytosis, or anemia, immunosuppression exposure, cytomegalovirus infection, and increased comorbidities, likely contribute to the increased risk of VTE in recipients compared to the general population [3,4,6,27]. In this study, recipients matched to members of the general population had a higher frequency of comorbidities, including previous VTE, coronary artery disease, hypertension, diabetes mellitus, peripheral vascular disease, and cancer.…”

“…In kidney transplant recipients, the reported incidence of posttransplant VTE varies widely (1-24%, reported range of follow-up 0.1-22 years) and is up to 8 times higher than that in the nonsurgical general population [2,3,4,5,6,7,8]. Risk factors for VTE that are unique to the transplant recipient population include the cause of end-stage renal disease (ESRD) [5], exposure to immunosuppression [3], low renal function 1 year after transplant [5], and low hemoglobin levels after transplant [3].…”

Venous thromboembolism in heart transplant recipients: Incidence, recurrence and predisposing factors

“…[3][4][5][6][7][8][9][10][11][12][13][14] In 2 large population-based cohorts from United Kingdom 15 and Canada, 16 the estimated incidence rates of VTE among individuals from the general population were, respectively, 1.33 and 1.22 cases per 1,000 persons-years, decreasing to 1.07 cases per 1,000 persons-years when cancer-related VTE episodes were excluded. 15 With variable follow-up duration among studies, the reported cumulative incidence of VTE varied between 4.5% and 9.1% in kidney transplant recipients, 3-6 between 8.6% and 29% in lung transplant recipients, 7-10 and between 0.4% and 4.6 % in liver transplant recipients.…”

Successful treatment of an acute sub-massive pulmonary embolism in a renal transplant patient with thrombolytic of low dosage in low infusion protocol

“…The cause of procoagulable state remains multifactorial. Patient age, prolonged bedrest after transplantation, surgical treatment and pelvic pathology, long time immunosuppressive drugs, antiphospholipid antibodies, and hemoglobin concentration level are important risk factors for thromboembolism (4,5). Alterations of hemostasis have been demonstrated in relation to immunosuppressive treatment in these patients, in particular to calcineurin inhibitors (5).…”