Risk and factors associated with venous thromboembolism following abdominal transplantation

Abstract

BackgroundVenous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort. MethodsThe 2014–2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes. ResultsOf ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25–1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34–1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02–1.63), coagulopathies (AOR 1.63, 95%CI 1.38–1.92), previous history of VTE (AOR 1.14, 95%CI 1.06–1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07–3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07–10.10), as well as infectious (AOR 2.59, 95%CI 1.55–4.21), cardiac (AOR 2.59, 95%CI 1.39–4.82), and respiratory (AOR 1.78, 95%CI 1.21–2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32–15.41), expenditures (+$42,000, 95%CI $24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32–15.41). ConclusionsVTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae.