Sequential changes in coagulation after renal transplantation: A thromboelastogram study

Abstract

BACKGROUND Chronic renal failure is associated with complex alterations in coagulation. The changes in coagulation that occur after renal transplantation have been studied only to a limited extent. The thromboelastogram (TEG) provides a global assessment of whole blood clotting. In this study, sequential changes in coagulation after renal transplantation were investigated in 8 patients using the TEG. METHODS The controls included normal healthy controls (n = 6) and patients on hemodialysis (n = 5), on peritoneal dialysis (n = 6), and long term after transplantation (n = 7). The TEG parameters measured included R‐time, K‐time, alpha angle, and maximum amplitude. RESULTS The TEG parameters pre‐transplantation demonstrated a hypercoagulable state. There was a trend toward normal coagulation immediately after transplantation (days 2–4) and a return to hypercoagulability thereafter, compared with the normal controls. There was no difference in the TEG parameters between the patients long term after transplantation and the normal controls. The dialysis patients were also hypercoagulable. CONCLUSIONS Patients with end‐stage renal failure on dialysis are hypercoagulable, and this persists in the early post‐transplant period. However patients long term after transplantation have normal coagulation.