Study's purpose

The study was conducted to review the clinical characteristics, management, and outcomes of patients with hemodialysis catheter-related right atrial thrombus (RAT) detected prior to kidney transplantation (KT), and to speculate its clinical significance.

Methods

Among patients who underwent KT between January 1995 and September 2015 in a single tertiary center, those who had a history of hemodialysis catheter-related RAT detected on 2-dimensional, transthoracic echocardiography (TTE) prior to KT were included to this retrospective study. Their medical records were reviewed regarding clinical characteristics, echocardiographic findings, management, outcomes of RAT, and KT outcomes.

Results

During the study period, 3,929 cases of KT were performed in 3,829 patients. Among them, a total of 11 patients (age, 41.4 ± 10.0 (SD) years; 8 (72.7%) females) were found to have hemodialysis catheter-related RAT prior to KT. All patients had catheter tip RAT; two (18.2%) of them had additional mural RAT. The average maximal diameter of the RAT was 23.2 ± 16.3 (SD) m. Nine (81.8%) of the 11 patients had no symptoms associated with RAT. One (9.1%) patient had paroxysmal atrial fibrillation and heart failure with a reduced ejection fraction. Three (27.3%) patients had blood tests for thrombogenic state, in which only 1 patient showed lupus anticoagulant positive. No patient had history of previous thromboembolic event. Four (36.3%) patients had their catheter replaced, while 5 (45.5%) patients had their catheter removed, and the other 2 (18.2%) patients kept their catheters in place. Six (54.5%) patients were anticoagulated with either heparin or warfarin. Duration of anticoagulation ranged from 7 days to 1289 days (median 100 days). Among them, 1 patient had surgical site bleeding necessitating surgical bleeding control. All patients had successful KT, without any complications related to RAT after KT. Median interval between the detection of RAT and KT was 93 days (range, 7 days – 1434 days) in 8 patients who went through living donor KT.

Conclusions

Hemodialysis catheter-related RAT that is incidentally detected on TTE prior to KT may not be as fatal as previously considered. Asymptomatic hemodialysis catheter-related RAT may not be a reason for delay or cancellation of KT. Long-term anticoagulation therapy after the disappearance of RAT seems to be unnecessary.

CITATION INFORMATION: Jeung S., Kim H., Baek C., Park S-.K. Hemodialysis Catheter-Related Right Atrial Thrombus Detected Prior to Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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