Intragraft coagulation events and delayed graft function in clinical renal transplantation.
BACKGROUND
Cold preservation, reperfusion damage, immunosuppressive drugs, and uremia-induced acquired thrombophilias increase the risk of thrombotic complications in renal transplantation. Intragraft fibrin deposition may be associated with delayed graft function.


METHODS
We studied coagulation and fibrinolysis in 45 patients of a larger trial in renal transplantation: perioperative antithymocyte globulin (group A, n=15), perioperative basiliximab (group B, n=16), and conventional triple therapy (group C, n=14). Blood samples for prothrombin fragment F1+2, plasminogen activator inhibitor (PAI)-1, d-dimer, tPA antigen, tPA activity, and platelet counts were obtained simultaneously at 1 and 5 min after reperfusion from iliac artery and graft vein for calculation of transrenal changes. Because antithymocyte globulin activates coagulation and fibrinolysis, group A was analyzed separately. Groups B and C were pooled (group BC).


RESULTS
In group BC, transrenal D-dimer release occurred at 1 min, tPA-antigen release at 1 and 5 min, and transrenal PAI-1 uptake at 5 min postreperfusion. tPA activity increased marginally only at 1 min. High graft tPA-antigen release at 5 min and D-dimer release at 1 min were associated with delayed graft function. In group A, transrenal tPA-antigen release occurred at 1 and 5 min and D-dimer release at 1 min. There were no transrenal F1+2 changes in either group.


CONCLUSIONS
Although graft PAI-1 uptake inhibits tPA activity, graft releases D-dimer at early reperfusion without concomitant F1+2 release. Data suggest thrombin and fibrin formation already before cold preservation during donor care and organ retrieval. This fibrin deposition increases risk of delayed graft function.
Turunen
Arto J
AJ
Department of Anesthesia and Intensive Care Medicine, Surgical Hospital, Helsinki University Hospital, Helsinki, Finland. arto.turunen@helsinki.fi
Lindgren
Leena
L
Salmela
Kaija T
KT
Kyllönen
Lauri E
LE
Petäjä
Jari
J
Pesonen
Eero J
EJ
D001777:Blood Coagulation; D002102:Cadaver; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007432:Intraoperative Period; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents