P1699EFFECT OF UREMIA IN THE POSTOPERATIVE OF PREEMPTIVE LIVING-DONOR KIDNEY TRANSPLANT PATIENTS

Abstract

Abstract Background and Aims Getting a preemptive kidney transplant has many benefits but no studies have assessed the potential deleterious effect of uremia on peritransplant complications. Uremic toxins interact negatively with biologic functions and may contribute to infections and bleeding or thormbosis. Method we evaluated 255 living-donor kidney transplant recipients (117 preemptive and 138 non-preemptive) from January 2006 to December 2015. Patients iniciated immunosuppression treatment 3 days prior to transplant. Exclusion criteria included: history of solid organ transplant, chronic immunosuppression treatment at the time of transplant (including prednisone), peritransplant rituximab/eculizumab treatment and HIV infection. An analysis of baseline characteristics and the incidence of symptomatic infection, bleeding or thrombosis during first week was performed in both groups. To analyze bleeding, the need of transfusion, drop of hematocrit in 72h and need of bladder washout was assessed. Results baseline characteristics are descrived in table 1. Non preemptive patients were older (50 vs 46 years) and had a higher prevalence of Diabetes Mellitus and dialypemia (22 vs 11% and 43 vs 30% respectively), without differences in the immunosupression scheme. The median eGFR in preemptive group at transplant was 12 ml/min. A more anemic profile was detected in the preemptive group with median hemoglobin of 116 vs 127 g/L in the non-preemptive group with no-differences in albumin levels. There were a total of 38 symptomatic infections (22 in the preemptive and 16 in the non-preemptive group), without statistical differences in the incidence between the groups (OR 1,75 CI 0,879-3,5, P =0,107). Hematocrit drop was greater in the non-preemptive group (8 vs 6 points in the first 72h p = 0.004) but thrombosis was more common in the preemptive group (5 vs 1, OR 6,116 CI 0,704-53,1, p = 0.062). Conclusion Uremia in preemptive living kidney transplant recipients does not seem to have influence on the incidence of infections in the first week after transplantation. The bleeding profile in the non-preemptive group in contrast to the prothrombotic profile in preemptive recipients needs further investigation in future studies that assess parameters of platelet and coagulation function as well as endothelial activation.