Risk Factors of Postoperative Bleeding in ABO-Incompatible Kidney Transplantation.

Abstract

Introduction Postoperative bleeding is one of the most serious complications of ABO-incompatible kidney transplantation (ABOi KT), nevertheless, what increases the risk of bleeding has never been reported. Maybe this is the first report to analyze the risk factor of postoperative bleeding in ABOi KT. Methods Between May 2009 and October 2013, we performed 70 ABOi KT and in 9 ABOi KT (12.8%), postoperative bleeding occurred. Patient characteristics divided into 3 category; general, immunologic, and hematologic and analyzed in bleeding group and non-bleeding group. The immunosuppressant regimens were identical, and any anticoagulation therapy was not performed in both groups during transplant surgery. Results On univariate logistic regression analysis, the number of preemptive transplantation, final ABO antibody titer after completion of therapeutic plasma exchange (TPE), the number of patient whose platelet count was lower than 100,000/m3 after TPE, prolongation of activated partial thromboplastin time, and abnormal result of platelet function test was significantly high in bleeding group.Table: No Caption available.Initial ABO antibody titer before TPE and the number of TPE, however, was not associated with the risk of postoperative bleeding. Conclusion Final ABO antibody titer was associated with the risk of postoperative bleeding, in the contrast to initial ABO antibody titer or the number of TPE was not. The proper preoperative management to lower the ABO antibody titer is crucial. Preoperative hematologic factors can give a clue to estimate the risk of bleeding and can be used as a tool to determine the high risk group of postoperative bleeding.