Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Patients with end stage renal disease (ESRD) often have significant cardiovascular comorbidities. Utilization of therapeutic anticoagulation (AC) and/or antiplatelet (AP) therapy poses an increased risk for bleeding in the perioperative kidney transplant (KT) setting. Therapeutic AC and AP may not be held for a sufficient amount of time prior to the KT operation as recommended by national guidelines. Through review of a large database of KT recipients, we aim to examine the effects of AC and AP therapy on clinical outcomes after KT.
*Methods: 21,855 KT recipients were screened from the 2008-2013 National Inpatient Sample of the Health Care Cost and Utilization Project. After matching for age and weight, 1,400 patients were included. 700 KT recipients receiving antithrombotic therapy (562 on AC and 138 on AP therapy) were compared to 700 patients not receiving antithrombotic therapy prior to KT. Outcomes were evaluated during the transplant admission. The primary outcome was the incidence of major bleeding which includes intracranial (ICH), gastrointestinal (GIH), subarachnoid (SAH), intracerebral (INCH), subdural (SDH), and extradural (EDH) hemorrhage. Secondary outcomes include the incidence of renal vein thrombosis (RVT), deep vein thrombosis (DVT), pulmonary embolism (PE), mortality, and length of stay (LOS).
*Results: Outcomes are displayed in Table 1. There was no difference in GIH or SDH in KT recipients on AC and/or AP compared to those not on AC or AP prior to KT. No differences were seen in the incidence of RVT, DVT, or mortality in patients on AC or AP prior to KT. No patients experienced ICH, SAH, INCH, or EDH. Patients receiving AC prior to transplant admission had a longer length of stay (6 vs. 5 days; p< 0.005).
|Mortality, n (%)||5 (0.8)||2 (0.4)||0.255||0 (0)||1 (0.7)||1.00|
|GIH, n (%)||3 (0.5)||6 (1.1)||0.315||0 (0)||1 (0.7)||1.00|
|SDH, n (%)||1 (0.1)||0 (0)||0.317||0 (0)||0 (0)||N/A|
|RVT, n (%)||2 (0.3)||3 (0.5)||0.654||0 (0)||1 (0.7)||1.00|
|DVT, n (%)||9 (1.6)||3 (0.5)||0.144||0 (0)||2 (1.4)||0.498|
|PE, n (%)||2 (0.3)||0 (0)||0.50||0 (0)||0 (0)||N/A|
|Length of stay, median [IQR]||6 [2-10]||5 [2-8]||< 0.005||5 [2-8]||6 [3-9]||0.117|
*Conclusions: KT recipients receiving AC or AP therapy prior to KT did not exhibit an increased incidence of hemorrhagic complications. Thromboembolic complications were also not increased in KT recipients receiving AC or AP therapy. Length of stay was longer in patients receiving AC prior to transplant admission, but not in patients receiving AP therapy. Preoperative use of AC or AP at the time of KT may be safe. Future studies should evaluate clinical outcomes with longer follow-up and identify any differences in clinical outcomes with regards to the type of AC or AP that is prescribed.
To cite this abstract in AMA style:Diamond A, Antonacci C, Lau K, Carlo ADi, Karhadkar S. Evaluation of Clinical Outcomes in Patients Receiving Antithrombotic Therapy Prior to Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-clinical-outcomes-in-patients-receiving-antithrombotic-therapy-prior-to-kidney-transplantation/. Accessed October 31, 2020.
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