Objective: Our objective was to determine whether the rate of venothromboembolic events (VTE) varied with early versus delayed prophylaxis administration. Associated bleeding complications were also examined.

Methods: We performed a single institution retrospective chart-review to evaluate all isolated kidney transplants performed from 6/2010 -7/2013, excluding liver/pancreas co-transplant patients. Timing of chemoprophylaxis administration was recorded and patients were grouped in two cohorts, based on pre- vs. post-operative administration. Other data included total number of units of red blood cells (pRBCs) transfused within 2 weeks of the operation, and14-day transfusion rate, 90-day VTE rates, and major bleeding complications were also noted. Statistical analyses were conducted using unpaired t-test for continuous variables and Fischer exact test for proportional event rates.

Results: A total of 254 patient records were examined comprised of 32% living donor transplants, 43% deceased standard criteria, 10% deceased expanded criteria and 15% donation after cardiac death. 89% of patients received a chemoprophylaxis regimen including 5000 U of subcutaneous heparin TID. Additional orders for sequential compression devices while in bed are standard for all transplant recipients. The 90-day rate of VTE in the pre-op prophylaxis cohort vs. those receiving prophylaxis post-operatively was 1.5% and 5.4% respectively (RR 0.28, 95% CI 0.04 – 2.21, p=0.28). There was a non-significant difference in major bleeding event rates between pre and post-operative heparin groups, 13.8%% and 9.0% respectively (RR 2.37, 95% CI 0.71-3.27, p=0.34). The mean number of units of pRBCs transfused within 2 weeks of operation in the pre-op and post-op cohort was 0.99 v 0.81 respectively, p= 0.51.

Conclusion: In this study, early administration of VTE chemoprophylaxis in isolated kidney transplant patients resulted in tendency towards increased risk of major bleeding complications and number of blood transfusions with a three-fold difference in VTE prevention. The study is underpowered to definitively recommend a chemoprophylaxis treatment strategy, but the trends identified suggest that further study is warranted.

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