Background: The incidence of venous thromboembolism (VTE) in kidney transplant recipients varies widely in the literature. The implications of VTE for morbidity and mortality in this population are not well described.

Methods: We conducted a retrospective study using linked healthcare databases in Ontario, Canada to determine the risk and complications of VTE in kidney transplant recipients from 2003-2013. We compared the incidence rate and 3-year cumulative incidence of VTE in recipients (n=4343) and a matched (1:4) sample of the general population (n=17,372). For recipients with evidence of a VTE post-transplant, we compared adverse clinical outcomes (death, graft loss) to matched (1:2) recipients without evidence of a VTE post-transplant.

Results: During a median follow-up of 5.2 years (interquartile range 2.8-7.9), 388 (8.9%) recipients developed a VTE compared to 254 (1.5%) in the matched general population (16.3 vs. 2.4 events per 1000 person-years; hazard ratio [HR] 7.1, 95% confidence interval [CI] 6.0-8.4; p<0.0001). The 3-year incidence of VTE in recipients was 5.5%. Of the 388 recipients who developed a VTE, 23 (5.9%) developed a recurrent VTE more than a year after the initial VTE. Recipients who experienced a post-transplant VTE had a higher risk of death (28.5% vs. 11.2%; 82.2 vs. 27.0 per 1000 person-years; HR 4.1, 95% CI 2.9-5.8; p<0.0001) and death-censored graft loss (13.1% vs. 7.5%; 41.1 vs. 18.7 per 1000 person-years; HR 2.3, 95% CI 1.4-3.6; p=0.0006) compared to matched recipients who did not experience a post-transplant VTE.

Conclusion: Kidney transplant recipients have a seven-fold higher risk of VTE compared to the general population with VTE conferring an increased risk of death and graft loss.

CITATION INFORMATION: Lam N, Garg A, Knoll G, Kim J, Lentine K, McArthur E, Naylor K, Bota S, Sood M. Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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