title: Risk factors for postoperative bleeding in ABO-incompatible kidney transplantation.
abstract: BACKGROUND
  The outcome of ABO-incompatible kidney transplantation (ABOi KT) has improved and is now comparable to that of ABO-compatible kidney transplantation (ABOc KT). However, ABOi KT may be associated with a higher risk of postoperative bleeding than ABOc KT.
  
  
  METHODS
  Seventy patients with ABOi KT were divided into a bleeding group (n = 9) and non-bleeding group (n = 61). General, immunologic, and hematological characteristics were compared to identify the risk factors for postoperative bleeding.
  
  
  RESULTS
  Pre-emptive transplantation and a high pre-transplant blood urea nitrogen level were more common in the bleeding group (p = 0.0176 and 0.023, respectively). A high anti-ABO antibody titer after plasmapheresis (median, ≥16; p = 0.0226), a low platelet count of ≤100 000/mm(3) after plasmapheresis (p = 0.0289), a prolonged activated partial thromboplastin time (p = 0.0073), and impaired platelet function (p = 0.0274) were associated with an increased risk of bleeding after ABOi KT.
  
  
  CONCLUSIONS
  Postoperative bleeding after ABOi KT was difficult to control and increased the risk of immediate graft loss (p = 0.015). Our results suggest that changes in coagulability associated with uremia and plasmapheresis may increase the risk of bleeding after ABOi KT.
authors: Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Mi Hyeong
authors: MH
authors: Kim
authors: Kang Woong
authors: KW
authors: Jun
authors: Jeong Kye
authors: JK
authors: Hwang
authors: Ji Il
authors: JI
authors: Kim
authors: Byung Ha
authors: BH
authors: Chung
authors: Bum Soon
authors: BS
authors: Choi
authors: Yong Soo
authors: YS
authors: Kim
authors: Chul Woo
authors: CW
authors: Yang
authors: In Sung
authors: IS
authors: Moon
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000276:immunology / Q000627:therapeutic use
chemical_list: D000017:ABO Blood-Group System; D007155:Immunologic Factors; D000069283:Rituximab
keywords: blood coagulation factors; blood group incompatibility; kidney transplantation; plasmapheresis; postoperative hemorrhage; uremia