Coagulatory state in renal transplants recipients. Is there a differrence between dialysis patients and pre-emptively transplanted patients?
G.J. Nieuwenhuijs-Moeke, T.A.J. van den Berg, S.J Bakker, T. Lisman, R.A. Pol
Chair(s): Drs. F.M. Molenaar
Thursday 9 march 2017
12:45 - 13:00h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 5
To prevent renal graft thrombosis different per- and postoperative anticoagulation strategies are used among centers, ranging from no therapy at all to unfractioned heparine for several days post transplantation. In our center preemptively transplanted patients receive 5000 IU of heparin before arterial clamping while dialysis patients do not. This difference is based on the historical assumption that patients on dialysis, and especially hemodialysis (HD), have a prolonged bleeding time compared to patients with end stage renal disease (ESRD). We hypothesized whether these assumptions are valid since HD is able to partially correct the uremic thrombopathy. Also, the impact of ESRD on the coagulation system is complex and both prolonged bleeding time, as well as enhanced thrombi formation are seen. In this study we compare the coagulatory state of dialysis patients with preemptively transplanted patients before and after renal transplantation. Stored plasma samples of patients participating in the VAPOR-1 trial were used. Fifty-seven recipients were included of which 28 were transplanted preemptively (preemptive group, PG) and 29 were on dialysis (dialysis group, DG). A control group (CG) of 37 healthy donors was included (CG). Sample points consisted of start surgery (T1), 5 minutes after reperfusion (T2) and 2 hours post-surgery (T3). Patients in the PG were given 5000 IE of heparin before clamping of the vessels. The following hemostatic and fibrinolytic parameters were analysed: PF4 and sP-selectin as specific platelet activation markers, vWf and F1+2 for coagulation activation and D-dimer for clot breakdown. Plasma potential was studied by thrombin generation (TGA) and clot lysis time (CLT) assays. At T1, PG and DG showed comparable increased platelet and coagulation activation as evidenced by elevated levels of PF4, F1+2 and D-dimer compared to CG as well as a decreased plasma fibrinolytic potential reflected by a prolonged CLT. At T2 increased levels of PF4 showed enhanced platelet activation in DG, compared to PG, in absence of concomitant coagulation activation. At T3, F1+2, PF4 and CLT were substantially higher in DG compared to PG. Compared to CG, prolonged CLT, but comparable levels of PF4 and D-dimer were seen in DG. Prior to transplantation, dialysis and pre-emptively transplanted patients show a comparable but enhanced coagulatory state. So, post-transplantation, dialysis patients show more activation of coagulation and inhibition of fibrinolysis, compared to the preemptive patients. This probably due to the use of heparin in the last group. Inhibition of fibrinolysis is also seen in dialysis patients compared to the control group.
