title: Intragraft coagulation events and delayed graft function in clinical renal transplantation.
abstract: 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.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Surgical Hospital, Helsinki University Hospital, Helsinki, Finland. arto.turunen@helsinki.fi
authors.forename: Arto J
authors.initials: AJ
authors.lastname: Turunen
authors.forename: Leena
authors.initials: L
authors.lastname: Lindgren
authors.forename: Kaija T
authors.initials: KT
authors.lastname: Salmela
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Kyllönen
authors.forename: Jari
authors.initials: J
authors.lastname: Petäjä
authors.forename: Eero J
authors.initials: EJ
authors.lastname: Pesonen
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents