Venous graft thrombosis in patients on peritoneal dialysis before transplantation.
BACKGROUND
It has been described that patients on peritoneal dialysis (PD) suffer from thrombotic events (vascular access, deep venous thrombosis, and graft thrombosis) more frequently after transplantation than other recipients. We analyzed the incidence of allograft thrombosis among patients transplanted in a 6-year period (January 1, 2000, to December 31, 2005) to identify etiological factors, such as inherited thrombophilia.


METHODS
We performed 197 renal transplants in 189 patients, including 115 who had been on hemodialysis (HD), 44 on PD, and 30 preemptive. We recorded immunological and demographic data, studied graft and patient survivals, and evaluated the hypercoagulable state of those who experienced graft thrombosis.


RESULTS
The mean age of the patients at transplantation was 49 years. There were no demographic or immunological differences between the three groups of patients, except for the number of previous blood transfusions and panel reactive antibodies (PRA) levels. Forty-seven grafts were lost in the first year; 14 suffered venous thrombosis, and there were 10 acute rejection epidoses (ARE), 7 death-censored graft failures, 3 chronic allograft nephropathies (CAN), 6 primary nonfunctions, 5 removed due to infection, 1 primary disease relapse, and 1 hemolytic-uremic syndrome. Of the 14 cases of thrombosis in 12 patients, 10 had been on PD and 4 on HD immediately before transplant. One-year graft and patient survivals were similar: 74% HD, 68% PD, 86% preemptive, and 93% HD, 95% PD, and 96% preemptive, respectively. The hypercoagulable state showed inherited thrombophilia patterns in some cases, but most of them were normal.


CONCLUSIONS
Renal graft thrombosis was responsible for graft lost in PD patients within the first year, while in the HD group it was ARE and in the preemptive cohort, death with a functioning graft. The hypercoagulable state pretransplant should be more accurately studied to identify thrombotic factors other than those which are inherited.
Palomar
R
R
Nephrology Department, Marqués de Valdecilla Hospital, Santander, Spain. nefpfm@humv.es
Morales
P
P
Rodrigo
E
E
Castañeda
O
O
Fernández-Fresnedo
G
G
Gómez-Alamillo
C
C
Arias
M
M
D002423:Cause of Death; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology* / Q000502:physiology; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D012082:Renal Veins / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D019851:Thrombophilia / Q000150:complications; D020246:Venous Thrombosis / Q000453:epidemiology / Q000473:pathology*