Analysis of coagulation parameters in the early period after kidney transplantation.
BACKGROUND
Hemorrhagic diatheses observed in patients with chronic renal failure result from platelet defects, vessel wall damage, and deficiency of II, VII, IX, and X clotting factors. In contrast, increased levels of fibrinogen and von Willebrand factor, as well as decreased plasma fibrinolytic activity, may lead to thrombotic complications in nephrotic syndrome. Successful kidney transplantation may reverse these disturbances. The aim of the study was to analyze plasma coagulation parameters in the early postoperative period.


METHODS
We studied 40 patients who received cadaveric kidney grafts in 2005 and 2006 for activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, and D-dimer concentrations as well as antithrombin III and protein C and S activities. Blood was collected before surgery and on postoperative days 1, 7, and 14.


RESULTS
The APTT, PT, and fibrinogen values did not differ before and after transplantation. The activity of antithrombin III pretransplantation was 80.9% +/- 19.3%, increasing to 114.2% +/- 25.5% on postoperative day 14. The activities of protein C and S pretransplantation were 115.1% +/- 32.2% and 120.2% +/- 51.6%, respectively, increasing to 150.2% +/- 56.6% and 139.5% +/- 35.4%, respectively, on postoperative day 14. D-dimer concentrations increased from 252.3 +/- 312.0 ng/mL before transplantation to 951.5 +/- 1170.8 and 739.1 +/- 1049.8 ng/mL on postoperative days 7 and 14, respectively.


CONCLUSIONS
Kidney transplantation increased plasma clotting inhibitor activity in the early postoperative period. The high level of D-dimer observed postoperatively suggested increased thrombotic processes in these patients.
Pawlicki
J
J
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland. pawlickij@poczta.onet.pl
Cierpka
L
L
Król
R
R
Ziaja
J
J
D000328:Adult; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation; D002102:Cadaver; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011517:Prothrombin Time; D014019:Tissue Donors
D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; D017293:Protein S; C036309:fibrin fragment D; D000990:Antithrombin III; D005340:Fibrinogen