#1617 Effect of pre-renal transplant anticoagulation and antiplatelet therapy on post-transplant outcomes: a retrospective single-center study

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Abstract Background and Aims The management of anticoagulation and antiplatelet therapy in stage V chronic kidney disease (CKD) patients undergoing renal transplantation is controversial. While some centers utilize reversal agents or procoagulants before surgery, other experiences suggest that renal transplantation can be safely performed without discontinuation of such treatments. The aim of this study is to assess the incidence of hemorrhagic and thrombotic complications within the first 72 hours post-transplant in anticoagulated or antiplatelet-treated patients compared to those without these treatments (control group). Method Retrospective cohort study of patients undergoing renal transplantation at our center between June 2018 and February 2022, with a 6-month post-transplant follow-up. Epidemiological, clinical, and analytical data were collected. Results 147 patients, predominantly male (60.3%). 8.1% were anticoagulated, and 16.3% were on antiplatelet therapy. Antiplatelet-treated patients were older (63 years) with a higher prevalence of cardiovascular disease history (54.2%). Anticoagulated patients showed a higher frequency of diabetes (50%) and atrial fibrillation (16.7%). The time on dialysis was also longer in anticoagulated or antiplatelet-treated patients (39.5 and 39 vs 33 months). 80.9% were first-time kidney transplant recipients from brain-dead donors, although the donor's age was lower in the control group. Ischemia time was similar in all three groups with no statistically significant differences. However, the length of hospital stay was longer for those receiving anticoagulation or antiplatelet therapy compared to the control group. 58.3% of anticoagulated patients received warfarin (pre-surgery INR of 1.5). In 50% of cases, reversal was performed using coagulation factors, vitamin K, fresh frozen plasma, or combinations of these therapies. 83.3% of antiplatelet-treated patients received aspirin, mainly for secondary prevention (54.2%), and only 8.3% received reversal therapy through plasma administration. The incidence of hemorrhagic and thrombotic complications was low (<5%) and did not significantly differ between anticoagulated or antiplatelet-treated patients and those without these treatments, although transfusion rates were higher in the anticoagulation group (75%) compared to 51.4% in the control group and 62.5% in antiplatelet-treated patients. Conclusion There are no significant differences regarding hemorrhagic and thrombotic complications between anticoagulated or antiplatelet-treated patients and those without these treatments, while the percentage of blood transfusions and hospital stay was higher in anticoagulated or antiplatelet-treated patients.