Anti-Thymocyte Globulin Induced Thrombocytopenia and Bleeding After Kidney Transplantation.
1Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of Rochester, Rochester, NY
2Department of Pharmacy, University of Rochester, Rochester, NY
3Department of Medicine, Division of Nephrology, University of Rochester, Rochester, NY.
Meeting: 2016 American Transplant Congress
Abstract number: D271
Keywords: Adverse effects, Antilymphocyte antibodies, Kidney transplantation, Risk factors
Session Information
Session Name: Poster Session D: Poster Session II: Kidney Complications-Other
Session Type: Poster Session
Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
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).
To cite this abstract in AMA style:
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. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/anti-thymocyte-globulin-induced-thrombocytopenia-and-bleeding-after-kidney-transplantation/. Accessed November 24, 2024.« Back to 2016 American Transplant Congress