*Purpose: Postoperative hemorrhage has been described at rates of 14 percent in kidney transplant (KT) literature. The preferred management of postoperative hemorrhage in this population is not well described. We hypothesized a difference in outcomes with operative vs. non-operative management of hemorrhage after kidney transplantation.

*Methods: We conducted a retrospective cohort study of consecutive kidney transplants from 2012-2019 (living and deceased donors). We classified patients with the complication of hemorrhage based on the objective finding of hematoma on either ultrasound or CT scan. Management was defined as operative (surgical intervention with or without transfusion) and non-operative (with or without transfusion).

*Results: We performed 1,758 KTs of which 135 (8%) demonstrated hematoma on ultrasound or CT scan (66 operative vs. 69 non-operative management). The clinical signs and symptoms of low urine output (p=0.044), drop in hemoglobin (p<0.000), abdominal pain (p=0.005), and MAP<70 mm Hg (p=0.034) were 92.5% predictive of postoperative hemorrhage in our kidney transplant patients. There were no differences between groups based on medical history, pre-op anticoagulation, anastomosis type, CIT, lowest hemoglobin, DGF or complications. Patients with non-operative treatment of postoperative hemorrhage had shorter lengths of stay (p<0.000), better graft survival (p=0.01), and better patient survival (p=0.01).

*Conclusions: We found better outcomes of graft and patient survival with shorter lengths of stay when we utilized non-operative management of postoperative hemorrhage in kidney transplant patients. Our findings suggest a role for conservative non-operative management in select patients. Ultimately, it is the surgeon’s choice of how best to manage the care of kidney transplant patients with postoperative hemorrhage.

« Back to 2020 American Transplant Congress