Hypercoagulable states in renal transplant candidates: Impact of anticoagulation upon incidence of renal allograft thrombosis

Gary S. Friedman, Herwig Ulf Meier-Kriesche, Bruce Kaplan, A. Scott Mathis, Luigi Bonomini, Nita Shah, Penny DeFranco, Martin Jacobs, Shamkant Mulgaonkar, Stuart Geffner, Neil Lyman, Catherine Paraan, Colleen Walsh, Waindel Belizaire, Michael Tshibaka

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Introduction. Although multiple studies of demographic variables have been associated with allograft thrombosis, these results are not routinely reproducible. Are ESRD patients with hypercoagulable states (HCS) (antithrombin III deficiency, protein S or C deficiency, activated protein C resistance, and anticardiolipin antibodies) at predictably greater risk for allograft thrombosis? Methods. Between 1996 and 1999, all renal transplant candidates were screened for hypercoagulability risk factors [HRF] (multiple arteriovenous access thromboses, prior deep vein thrombosis, prior allograft thrombosis, collagen vascular disease, multiple miscarriages, diabetes, autoimmune disease, and Fabry's disease). HRF(+) candidates were then tested for HCS status. We administered preemptive posttransplant i.v. Heparin in HCS(+) patients and observed the impact of this intervention upon the incidence of allograft thrombosis. We compared demographic data and incidence of allograft thrombosis in an historic control (346 patients transplanted between June 31, 1992, and March 5, 1996) not tested for HCS and a study cohort (502 patients transplanted between March 6, 1996, and June 31, 1999) prospectively screened for HRF. HRF(+) patients who were HCS(+) in the study cohort received i.v. heparin immediately after transplant and p.o. warfarin as outpatients. Results. Demographic characteristics previously implicated in allograft thrombosis were equivalently distributed in both cohorts with the exceptions that more living-donor transplants (33.1% vs. 15.3%) were performed in study cohort, CIT>24 hr occurred in more control patients (37.3% vs. 22.1%) and more study patients (16.7% vs. 0%) received tacrolimus. Hypercoagulable states were found upon reevaluating five of seven controls (71.4%), who lost prior allografts to thrombosis. Hypercoagulable states were prospectively detected in 10 study patients with hypercoagulability risk factors. Most (9 of 10) study patients receiving anticoagulation have achieved long-term allograft function. Study group allograft thrombosis incidence was reduced (1.59% vs. 4.05%). Hypercoagulable states were demonstrated in most episodes of allograft thrombosis. Control patients who lost prior allografts to thrombosis were anticoagulated after retransplantation and 100% achieved long-term allograft function. Conclusions. Long-term allograft function has been achieved in 90% of study patients when prophylactically anticoagulating study patients with hypercoagulable states. A 2.6-fold reduction in the expected incidence of allograft thrombosis was observed in anticoagulated patients with hypercoagulable states.

Original languageEnglish (US)
Pages (from-to)1073-1078
Number of pages6
JournalTransplantation
Volume72
Issue number6
StatePublished - Sep 27 2001
Externally publishedYes

Fingerprint

Allografts
Thrombosis
Transplants
Kidney
Incidence
Thrombophilia
Cohort Studies
Demography
Heparin
Antithrombin III Deficiency
Protein S Deficiency
Protein C Deficiency
Activated Protein C Resistance
Fabry Disease
Collagen Diseases
Anticardiolipin Antibodies
Living Donors
Tacrolimus
Spontaneous Abortion
Warfarin

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Friedman, G. S., Meier-Kriesche, H. U., Kaplan, B., Scott Mathis, A., Bonomini, L., Shah, N., ... Tshibaka, M. (2001). Hypercoagulable states in renal transplant candidates: Impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation, 72(6), 1073-1078.

Hypercoagulable states in renal transplant candidates : Impact of anticoagulation upon incidence of renal allograft thrombosis. / Friedman, Gary S.; Meier-Kriesche, Herwig Ulf; Kaplan, Bruce; Scott Mathis, A.; Bonomini, Luigi; Shah, Nita; DeFranco, Penny; Jacobs, Martin; Mulgaonkar, Shamkant; Geffner, Stuart; Lyman, Neil; Paraan, Catherine; Walsh, Colleen; Belizaire, Waindel; Tshibaka, Michael.

In: Transplantation, Vol. 72, No. 6, 27.09.2001, p. 1073-1078.

Research output: Contribution to journalArticle

Friedman, GS, Meier-Kriesche, HU, Kaplan, B, Scott Mathis, A, Bonomini, L, Shah, N, DeFranco, P, Jacobs, M, Mulgaonkar, S, Geffner, S, Lyman, N, Paraan, C, Walsh, C, Belizaire, W & Tshibaka, M 2001, 'Hypercoagulable states in renal transplant candidates: Impact of anticoagulation upon incidence of renal allograft thrombosis', Transplantation, vol. 72, no. 6, pp. 1073-1078.
Friedman GS, Meier-Kriesche HU, Kaplan B, Scott Mathis A, Bonomini L, Shah N et al. Hypercoagulable states in renal transplant candidates: Impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation. 2001 Sep 27;72(6):1073-1078.
Friedman, Gary S. ; Meier-Kriesche, Herwig Ulf ; Kaplan, Bruce ; Scott Mathis, A. ; Bonomini, Luigi ; Shah, Nita ; DeFranco, Penny ; Jacobs, Martin ; Mulgaonkar, Shamkant ; Geffner, Stuart ; Lyman, Neil ; Paraan, Catherine ; Walsh, Colleen ; Belizaire, Waindel ; Tshibaka, Michael. / Hypercoagulable states in renal transplant candidates : Impact of anticoagulation upon incidence of renal allograft thrombosis. In: Transplantation. 2001 ; Vol. 72, No. 6. pp. 1073-1078.
@article{b245b51c75134d859a07af9aea3520f0,
title = "Hypercoagulable states in renal transplant candidates: Impact of anticoagulation upon incidence of renal allograft thrombosis",
abstract = "Introduction. Although multiple studies of demographic variables have been associated with allograft thrombosis, these results are not routinely reproducible. Are ESRD patients with hypercoagulable states (HCS) (antithrombin III deficiency, protein S or C deficiency, activated protein C resistance, and anticardiolipin antibodies) at predictably greater risk for allograft thrombosis? Methods. Between 1996 and 1999, all renal transplant candidates were screened for hypercoagulability risk factors [HRF] (multiple arteriovenous access thromboses, prior deep vein thrombosis, prior allograft thrombosis, collagen vascular disease, multiple miscarriages, diabetes, autoimmune disease, and Fabry's disease). HRF(+) candidates were then tested for HCS status. We administered preemptive posttransplant i.v. Heparin in HCS(+) patients and observed the impact of this intervention upon the incidence of allograft thrombosis. We compared demographic data and incidence of allograft thrombosis in an historic control (346 patients transplanted between June 31, 1992, and March 5, 1996) not tested for HCS and a study cohort (502 patients transplanted between March 6, 1996, and June 31, 1999) prospectively screened for HRF. HRF(+) patients who were HCS(+) in the study cohort received i.v. heparin immediately after transplant and p.o. warfarin as outpatients. Results. Demographic characteristics previously implicated in allograft thrombosis were equivalently distributed in both cohorts with the exceptions that more living-donor transplants (33.1{\%} vs. 15.3{\%}) were performed in study cohort, CIT>24 hr occurred in more control patients (37.3{\%} vs. 22.1{\%}) and more study patients (16.7{\%} vs. 0{\%}) received tacrolimus. Hypercoagulable states were found upon reevaluating five of seven controls (71.4{\%}), who lost prior allografts to thrombosis. Hypercoagulable states were prospectively detected in 10 study patients with hypercoagulability risk factors. Most (9 of 10) study patients receiving anticoagulation have achieved long-term allograft function. Study group allograft thrombosis incidence was reduced (1.59{\%} vs. 4.05{\%}). Hypercoagulable states were demonstrated in most episodes of allograft thrombosis. Control patients who lost prior allografts to thrombosis were anticoagulated after retransplantation and 100{\%} achieved long-term allograft function. Conclusions. Long-term allograft function has been achieved in 90{\%} of study patients when prophylactically anticoagulating study patients with hypercoagulable states. A 2.6-fold reduction in the expected incidence of allograft thrombosis was observed in anticoagulated patients with hypercoagulable states.",
author = "Friedman, {Gary S.} and Meier-Kriesche, {Herwig Ulf} and Bruce Kaplan and {Scott Mathis}, A. and Luigi Bonomini and Nita Shah and Penny DeFranco and Martin Jacobs and Shamkant Mulgaonkar and Stuart Geffner and Neil Lyman and Catherine Paraan and Colleen Walsh and Waindel Belizaire and Michael Tshibaka",
year = "2001",
month = "9",
day = "27",
language = "English (US)",
volume = "72",
pages = "1073--1078",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Hypercoagulable states in renal transplant candidates

T2 - Impact of anticoagulation upon incidence of renal allograft thrombosis

AU - Friedman, Gary S.

AU - Meier-Kriesche, Herwig Ulf

AU - Kaplan, Bruce

AU - Scott Mathis, A.

AU - Bonomini, Luigi

AU - Shah, Nita

AU - DeFranco, Penny

AU - Jacobs, Martin

AU - Mulgaonkar, Shamkant

AU - Geffner, Stuart

AU - Lyman, Neil

AU - Paraan, Catherine

AU - Walsh, Colleen

AU - Belizaire, Waindel

AU - Tshibaka, Michael

PY - 2001/9/27

Y1 - 2001/9/27

N2 - Introduction. Although multiple studies of demographic variables have been associated with allograft thrombosis, these results are not routinely reproducible. Are ESRD patients with hypercoagulable states (HCS) (antithrombin III deficiency, protein S or C deficiency, activated protein C resistance, and anticardiolipin antibodies) at predictably greater risk for allograft thrombosis? Methods. Between 1996 and 1999, all renal transplant candidates were screened for hypercoagulability risk factors [HRF] (multiple arteriovenous access thromboses, prior deep vein thrombosis, prior allograft thrombosis, collagen vascular disease, multiple miscarriages, diabetes, autoimmune disease, and Fabry's disease). HRF(+) candidates were then tested for HCS status. We administered preemptive posttransplant i.v. Heparin in HCS(+) patients and observed the impact of this intervention upon the incidence of allograft thrombosis. We compared demographic data and incidence of allograft thrombosis in an historic control (346 patients transplanted between June 31, 1992, and March 5, 1996) not tested for HCS and a study cohort (502 patients transplanted between March 6, 1996, and June 31, 1999) prospectively screened for HRF. HRF(+) patients who were HCS(+) in the study cohort received i.v. heparin immediately after transplant and p.o. warfarin as outpatients. Results. Demographic characteristics previously implicated in allograft thrombosis were equivalently distributed in both cohorts with the exceptions that more living-donor transplants (33.1% vs. 15.3%) were performed in study cohort, CIT>24 hr occurred in more control patients (37.3% vs. 22.1%) and more study patients (16.7% vs. 0%) received tacrolimus. Hypercoagulable states were found upon reevaluating five of seven controls (71.4%), who lost prior allografts to thrombosis. Hypercoagulable states were prospectively detected in 10 study patients with hypercoagulability risk factors. Most (9 of 10) study patients receiving anticoagulation have achieved long-term allograft function. Study group allograft thrombosis incidence was reduced (1.59% vs. 4.05%). Hypercoagulable states were demonstrated in most episodes of allograft thrombosis. Control patients who lost prior allografts to thrombosis were anticoagulated after retransplantation and 100% achieved long-term allograft function. Conclusions. Long-term allograft function has been achieved in 90% of study patients when prophylactically anticoagulating study patients with hypercoagulable states. A 2.6-fold reduction in the expected incidence of allograft thrombosis was observed in anticoagulated patients with hypercoagulable states.

AB - Introduction. Although multiple studies of demographic variables have been associated with allograft thrombosis, these results are not routinely reproducible. Are ESRD patients with hypercoagulable states (HCS) (antithrombin III deficiency, protein S or C deficiency, activated protein C resistance, and anticardiolipin antibodies) at predictably greater risk for allograft thrombosis? Methods. Between 1996 and 1999, all renal transplant candidates were screened for hypercoagulability risk factors [HRF] (multiple arteriovenous access thromboses, prior deep vein thrombosis, prior allograft thrombosis, collagen vascular disease, multiple miscarriages, diabetes, autoimmune disease, and Fabry's disease). HRF(+) candidates were then tested for HCS status. We administered preemptive posttransplant i.v. Heparin in HCS(+) patients and observed the impact of this intervention upon the incidence of allograft thrombosis. We compared demographic data and incidence of allograft thrombosis in an historic control (346 patients transplanted between June 31, 1992, and March 5, 1996) not tested for HCS and a study cohort (502 patients transplanted between March 6, 1996, and June 31, 1999) prospectively screened for HRF. HRF(+) patients who were HCS(+) in the study cohort received i.v. heparin immediately after transplant and p.o. warfarin as outpatients. Results. Demographic characteristics previously implicated in allograft thrombosis were equivalently distributed in both cohorts with the exceptions that more living-donor transplants (33.1% vs. 15.3%) were performed in study cohort, CIT>24 hr occurred in more control patients (37.3% vs. 22.1%) and more study patients (16.7% vs. 0%) received tacrolimus. Hypercoagulable states were found upon reevaluating five of seven controls (71.4%), who lost prior allografts to thrombosis. Hypercoagulable states were prospectively detected in 10 study patients with hypercoagulability risk factors. Most (9 of 10) study patients receiving anticoagulation have achieved long-term allograft function. Study group allograft thrombosis incidence was reduced (1.59% vs. 4.05%). Hypercoagulable states were demonstrated in most episodes of allograft thrombosis. Control patients who lost prior allografts to thrombosis were anticoagulated after retransplantation and 100% achieved long-term allograft function. Conclusions. Long-term allograft function has been achieved in 90% of study patients when prophylactically anticoagulating study patients with hypercoagulable states. A 2.6-fold reduction in the expected incidence of allograft thrombosis was observed in anticoagulated patients with hypercoagulable states.

UR - http://www.scopus.com/inward/record.url?scp=0035959971&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035959971&partnerID=8YFLogxK

M3 - Article

C2 - 11579303

AN - SCOPUS:0035959971

VL - 72

SP - 1073

EP - 1078

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 6

ER -