Venous thromboembolism in live kidney donors--a prospective study.
OBJECTIVE
The aim of this study was to evaluate risk factors for venous thromboembolism (VTE) and deep vein thrombosis after living donor nephrectomy in a center using extensive preoperative screening and perioperative venous duplex scan.


METHODS
Thrombophilia screening and pre- and postoperative ultrasonographies were performed in 130 consecutive living kidney donors (laparoscopic 105, open 25). Donors were followed prospectively for at least 3 months. All donors received prophylaxis with the low molecular weight heparin enoxaparin and compression stockings. Donors with increased risk received a double dose of enoxaparin and the prophylaxis was continued for 6 weeks. Donors with venous thrombosis at discharge duplex also received prolonged prophylaxis.


RESULTS
The frequency of thrombophilia was similar to what can be expected in the Swedish population (four with factor V Leiden and one each with protein S deficiency, prothrombin gene mutation, and anticardiolipin antibodies). Preoperative duplex was normal. Three donors had small postoperative deep vein thrombosis. Twelve donors (9.2%) received an intensified and prolonged prophylaxis. No further thromboembolic complications developed in 3 postoperative months.


CONCLUSIONS
With the present protocol for preoperative evaluation, perioperative duplex screening, and prophylaxis, the risk of postoperative VTE is low after living donor nephrectomy. Given that 9.2% had risk factors or developed deep vein thrombosis, the extraordinary situation of an operation being performed on a healthy person who has no therapeutic benefit and the low incidence of VTE in the present study, we recommend the presented approach to be implemented more broadly and that further studies are performed in larger cohorts.
Biglarnia
Alireza
A
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Bergqvist
David
D
Johansson
Maria
M
Wadström
Jonas
J
D015992:Body Mass Index; D005260:Female; D006801:Humans; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology*