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Investigating Role of Early VTE Chemoprophylaxis in Kidney Transplant

D. Kendrick,1 E. Kudlaty,1 A. Kim,1 P. Moorehead,1 J. Augustine,2 E. Sanchez,2 V. Kashyap,1 K. Woodside.2

1Vascular Surgery, University Hospitals-Case Medical Center, Cleveland, OH
2Transplant Institute, University Hospitals-Case Medical Center, Cleveland, OH.

Meeting: 2015 American Transplant Congress

Abstract number: C229

Keywords: Anticoagulation, Blood transfusion, Kidney transplantation, Vascular disease

Session Information

Date: Monday, May 4, 2015

Session Name: Poster Session C: Surgical Issues/Ureteral Complications

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

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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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To cite this abstract in AMA style:

Kendrick D, Kudlaty E, Kim A, Moorehead P, Augustine J, Sanchez E, Kashyap V, Woodside K. Investigating Role of Early VTE Chemoprophylaxis in Kidney Transplant [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/investigating-role-of-early-vte-chemoprophylaxis-in-kidney-transplant/. Accessed February 23, 2019.

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