Venous thromboembolism (VTE) is one of the most preventable causes of hospital mortality. Per the CHEST guidelines, a 6% VTE prevalence is considered high risk and 3% is considered moderate risk in non-orthopedic surgeries. There are few studies that have assessed the prevalence of VTE post-kidney transplant with variable use of chemoprophylaxis among transplant centers. The purpose of this study is to assess the prevalence of VTE post-kidney transplant where chemoprophylaxis is not routinely utilized. This was a retrospective cohort study of adult recipients receiving a kidney transplant between 2007 and 2012. Multi-organ transplant recipients and early graft loss secondary to vascular complications were excluded. Thymoglobulin induction with triple immunosuppression was routinely used. Of the 430 patients enrolled, 351 patients were eligible including 217 deceased donor and 134 living donor recipients. At the time of transplant, 14 patients had documented hypercoagulable disease states (history of previous thromboembolism or serological testing). The primary outcome was to assess VTE prevalence within 35 days post-transplant. Secondary outcomes were VTE prevalence within 1 year, living vs. deceased donor recipients, and prevalence in patients with hypercoagulable disease states. A VTE was defined as a radiographically diagnosed pulmonary embolism (PE) or deep venous thrombosis with clinical symptoms. The VTE prevalence was 3.1% within 35 days post-transplant, with a total of 11 VTE events, including 2 PEs. VTE prevalence within 1 year was 4.8%. VTE prevalence in deceased vs. living donor recipients was 4.1% vs. 1.4% (p=NS) within 35 days, and 6.5% vs. 2.2% (p=NS) within 1 year. PE prevalence within 35 days in deceased vs. living donor recipients was 0.9% vs. 0% (p=NS). Finally, VTE prevalence in patients with and without hypercoagulable disease states was 14% vs. 2.6% (p=NS). The data suggests that kidney transplant surgery is moderate risk and chemoprophylaxis may be considered. Patients receiving deceased donor transplants may be at an increased VTE risk as compared to living donor recipients. Chemoprophylaxis should be considered in patients with hypercoagulable disease states at the time of transplant. The lower than anticipated rate of VTE could be secondary to the high rate of use of anti-platelet agents in this patient population. Further prospective studies are needed to further describe the risk of VTE in renal transplant patients.

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