Thromboembolic complications (TECs) are dreaded complications after kidney transplantation (KTx). Consequences are severe and can result in delayed graft function or even graft loss. Perioperative use of anticoagulation may have a preventive role in this, but a (inter)national protocol is missing due to lack of consensus on postoperative bleeding risks. Our objective was to determine the incidence of TECs and bleeding complications in relation to the use of pre- and intraoperative antiplatelet/anticoagulation therapy in KTx and to identify risk factors. This retrospective analysis comprises all patients >18 years, who underwent a KTx between 2011-2016 in 2 centers in The Netherlands. Exclusion criteria were combined transplantations or missing data on antiplatelet/anticoagulation therapy. Events were scored in case they occurred ≤ 7 days post-transplant. TECs were defined as an arterial/venous renal thrombosis, deep vein thrombosis or pulmonary embolism. Bleeding was scored after confirmation with imaging. Primary outcome measures were the incidence of TECs and bleeding in relation to the use of pre-/intraoperative anticoagulation. Secondary outcome parameters were risk factors correlated to TECs and postoperative bleeding. A total of 2000 patients were included and stratified for TEC or bleeding. Mean age was 55±14 years, 59% was male and 60% received a living donor kidney, 20% a DBD kidney and 20% a DCD kidney. Twenty-one patients (1.1%) had a TEC ≤ 7 days post-transplant. Bleeding complications occurred in 87 (4.4%) patients. Univariate regression analysis for TEC identified (P<0.05) multiple donor arteries (OR 2.79) and recipient obesity (BMI>30 kg/m2, OR 2.85) as potential risk factors. Multivariate analysis for postoperative bleeding identified (Bonferroni adjusted P<0.004) cardiovascular disease (OR 2.30) and preemptive transplantation (OR 2.35) as risk factors. Intraoperative heparin, use of vitamin K antagonists or antiplatelet therapy is not associated with an increased risk of bleeding and appears to be safe when preventing TECs.

CITATION INFORMATION: van den Berg T., Minnee R., Nieuwenhuijs-Moeke G., Bakker S., Pol R. The Effect of Perioperative Antiplatelet/Anticoagulant Therapy on the Incidence of Early Postoperative Thromboembolic Complications and Bleeding in Kidney Transplantation – A Dual Center Retrospective Cohort Study of 2000 Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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