POS-750 THROMBOEMBOLISM IN KIDNEY TRANSPLANT RECIPIENTS: PREVALENCE AND OUTCOMES OVER 13 YEARS

Abstract

Thromboembolism is more common in kidney transplant recipients(KTR) than the general population. As the number of studies evaluating arterial andvenous thromboembolism (VTE) in KTR are very scarce, the magnitude and the riskfactors are undefined. Thromboprophylaxis poses a challenge as the risk ofthrombosis must be balanced against the risk of bleeding. It was a retrospective analysis of 2124 patients of age more than 18 yearsold, who had undergone kidney transplantation between January 2007 to December 2019. A VTE was defined as a radiographically diagnosed pulmonary embolism (PE)or deep venous thrombosis (DVT) with or without clinical symptoms. No patient wasgiven chemoprophylaxis. The primary outcome was to assess prevalence of the VTEepisode. Secondary outcomes were assessment of the timing of occurrence of thethromboembolic events after transplantation, determining the risk factors, estimationof rate of recurrence after thromboprophylaxis withdrawal, and outcomes. Multipleorgan transplant recipients and early graft loss due to vascular complications werenot included in the study. Of 2124 patients, 67 (3.1%) patients were found to have VTE (1 deceased-donor and 66 living donor recipients). 70 percent of patients were male. The median follow-up was 3.9 years (range 6 months -13 years). The mean age at transplantation was 42 years (± 10). A total of 75 VTE events were recorded. Twenty events were asymptomatic. No episode of VTE was recorded in the first-month post-transplantation. Four patients experienced a recurrence of VTE. 52 cases were diagnosed with lower limb DVT, 5 cases were upper limb DVT, 6 cases with pulmonary embolism, 2 cases were cerebral venous sinus thrombosis and 2 cases were of iliofemoral thrombosis. Cytomegalovirus infection and cancer were found to be related to higher chances of VTE. No increased risk of VTE was observed among patients receiving cyclosporine, a mammalian target of rapamycin inhibitors. The risk was not affected by the patient’s age, obesity, primary etiology of end-stage renal disease, prior dialysis modality, or acute rejections. The over-all estimated 5-year graft survival of the VTE group was 70.3%. The data suggest that kidney transplant surgery is a moderate risk for. Chemoprophylaxis should be considered in patients with hypercoagulable disease states at the time of transplant. Further prospective studies are needed to further describe the risk of VTE in KTRs.