title: Postoperative surgical-site hemorrhage after kidney transplantation: incidence, risk factors, and outcomes.
abstract: Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical-site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24-hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical-site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m2increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical-site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Laureen D
authors.initials: LD
authors.lastname: Hachem
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Sang Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012307:Risk Factors
keywords: incidence; kidney transplant; outcomes; risk factors; surgical-site hemorrhage