Risk factors for postoperative bleeding in ABO-incompatible kidney transplantation.

Abstract

The outcome of ABO-incompatible kidney transplantation (ABOi KT) has improved and is now comparable to that of ABO-compatible kidney transplantation (ABOc KT). However, ABOi KT may be associated with a higher risk of postoperative bleeding than ABOc KT. Seventy patients with ABOi KT were divided into a bleeding group (n=9) and non-bleeding group (n=61). General, immunologic, and hematological characteristics were compared to identify the risk factors for postoperative bleeding. Pre-emptive transplantation and a high pre-transplant blood urea nitrogen level were more common in the bleeding group (p=0.0176 and 0.023, respectively). A high anti-ABO antibody titer after plasmapheresis (median, ≥16; p=0.0226), a low platelet count of ≤100000/mm(3) after plasmapheresis (p=0.0289), a prolonged activated partial thromboplastin time (p=0.0073), and impaired platelet function (p=0.0274) were associated with an increased risk of bleeding after ABOi KT. Postoperative bleeding after ABOi KT was difficult to control and increased the risk of immediate graft loss (p=0.015). Our results suggest that changes in coagulability associated with uremia and plasmapheresis may increase the risk of bleeding after ABOi KT.