D-dimer, Von Willibrand factor, and ADAMTS13 in renal transplant recipients

Abstract

Introduction Chronic kidney disease and renal transplants are associated with activation of coagulation. Microvascular thrombosis and fibrinolytic disorders have been recognized as main causes of allograft rejection in renal transplant recipients. Aims The aim was to evaluate D-dimer, Von Willibrand factor (VWF), and ADAMTS13 activity plasma levels in renal transplant recipients and investigate the association of these parameters and creatinine plasma levels, estimated glomerular filtration rate (eGFR), and time after transplantation. Participants and methods A total of 40 renal transplant recipients clinically stable at National Institute of Urology and Nephrology, 5–192 months after transplantation were enrolled in the study. Dimer, VWF, and ADAMTS13 activity levels were measured. Result We observed significant higher levels of ADAMTS13 (P = 0.03) in subgroup Cr3 (55.9%) with creatinine greater than 2.0 mg/dl as compared with Cr1 (43.3%) with creatinine less than 1.4 mg/dl and insignificant higher levels of D-dimer and VWF in subgroup Cr3 (566.22 ng/ml and 253.5 IU/dl, respectively) as compared with Cr1 (363.3 ng/ml and 240.6 IU/dl, respectively). We observed also insignificant higher levels of D-dimer, VWF, and ADAMTS13 in subgroup with eGFR less than 60 ml/min/1.73 m2 (478.6 ng/ml, 220.6 IU/dl, and 43.3%, respectively) as compared with eGFR greater than or equal to 60 ml/min/1.73 m2 (322.73 ng/ml, 207.32 IU/dl, and 42%, respectively). There was a weak association between eGFR and D-dimer [odds ratio (OR)=−0.033, P = 0.01] and VWF (OR=−0.053, P = 0.044) and a weak association between creatinine plasma levels (>2.0 mg/dl) with D-Dimer (OR = 0.001, P = 0.003) and VWF (OR = 0.001, P = 0.038). Conclusion D-dimer, VWF, and ADAMTS were weakly associated with creatinine plasma levels and graft function. Other studies with a larger number of renal transplant recipients and from more than one center must clarify the role of hemostatic markers, especially, D-dimer, VWF, and ADAMTS13.