COMPLICATIONS - METABOLIC

D.J. Conti¹, L. Kushnir², R. Lefebvre², M.H. Gallichio^2
1Surgery, Albany Medical Center, Albany,New York/UNITED STATES OF AMERICA, ²Surgery, Albany Medical Center, Albany, New York/UNITED STATES OF AMERICA

Body: Introduction. In response to the development of two post-operative hemorrhagic complications on day 5 after renal transplantation associated with unexplained coagulopathy (INR>2.5) in 2004, we began to routinely monitor the INR on postoperative day 2 in all renal transplant recipients. Methods. Between January 1, 2005 and September 31, 2009, 261 renal transplants were performed at our institution. All patients received induction therapy with either Thymoglobulin (deceased-donor and live-unrelated donor recipients) initiated within 24 hours of renal revascularization at a mean daily dose of 1mg/kg through day 6 (Group A, n=235) or Simulect (live-related donor recipients) 20mg initiated prior to renal revascularization and repeated on day 4 (group B, n=26). All patients with an INR>1.5 on day 2 were treated with fresh frozen plasma (FFP) and/or vitamin K, 1 mg intravenously, to reverse the coagulopathy with continued daily INR monitoring. Demographics between the two recipient groups were noted to be similar for age, gender, ethnicity, diabetes, maintenance immunosuppression and preoperative serum albumin level. Results. The mean immediate preoperative INR was 0.97 and 0.98 for Group A and B recipients, respectively. On postoperatve day 2, the mean INR was 1.35 (range 0.9-7.6) in group A and 1.09 (range 0.9-2.4) in Group B recipients (p=0.1). Furthermore, forty six of the 235 (20%) group A patients were noted to have an INR>1.5 postoperatively and required therapy with FFP and/or vitamin K compared to only 1 of 26 (4%) Group B patients (p<0.05). Only one clinically significant postoperative hemorrhagic complication (0.4%) developed during this four and a half year interval. Conclusion. Induction therapy with Thymoglobulin, compared to Simulect, after renal transplantation was associated with an increased rate of an elevated INR (>1.5) during the post-operative period. This trend toward a potentially dangerous coagulopathy reached statistical significance. Our data indicates that renal transplant recipients treated with Thymoglobulin induction therapy should undergo careful monitoring of postoperative coagulation factor function to prevent a severe coagulopathic state and potential hemorrhagic complications.

Disclosure: All authors have declared no conflicts of interest.