Background: Bleeding is a significant challenge after renal transplantation. Anti-thymocyte globulin (ATG) induced thrombocytopenia may increase bleeding after kidney transplantation (KTx), but this association has not been assessed. The purpose of this study was to investigate ATG as a risk factor for bleeding following renal allograft transplantation.

Methods: We performed a retrospective, cohort study in adult KTx recipients transplanted between January 1, 2011 and April 30, 2015. Patients were categorized based on the presence of a bleeding event, classified as major (overt causing death, critical site, hematoma requiring intervention, or bleeding requiring transfusion of at least 2 units of PRBCs in a 72 hour period) or clinically relevant non-major (CRNMB, overt and requiring less than 2 units of PRBCs). Bleeding was assessed in the 30 day post-operative period, and adjudicated by a blinded committee.

Results: A total of 258 patients were transplanted. Median age was 52 years, 59.3% were male, and 12.0% were kidney retransplants. Of 258 patients, 43 (16.7%) had bleeding events, 38 (14.7%) major (1 fatal) and 5 (1.9%) CRNMB. Bleeding requiring at least 2 units of PRBCs [21 (48.8%)] and hematoma requiring intervention [12 (27.9%)] were the most commonly met criteria for major bleeding events. Bleeding occurred in 18 of 83 (21.7%) patients who received ATG induction therapy vs 25 of 175 (14.3%) patients with alternative induction (p = 0.14). The rate of bleeding with a platelet nadir of < 50,000/[micro]L was 54.5% and nadir < 100,000/[micro]L was 30.2%. Multiple logistic regression demonstrated two independent risks for bleeding after adjusting for confounders: platelet count nadir <100,000/[micro]L (OR 2.3, CI 1.03-4.89) and post-transplant plasma exchange (OR 4.0, CI 1.2-13.6). Given the association with ATG administration and thrombocytopenia we assessed the interaction with bleeding in the multivariate model, however, this was not found to be an effect modifier.

Conclusions: Our study demonstrated that thrombocytopenia and plasma exchange were independent predictors of bleeding after KTx, however, use of ATG was not found to increase risk.

CITATION INFORMATION: Dokus M, Patel A, Iuppa J, Venniro E, Danzig A, Cooley J, Taylor J, Kashyap R, Orloff M. Anti-Thymocyte Globulin Induced Thrombocytopenia and Bleeding After Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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