Transplant Trial Watch

Preemptively and non-preemptively transplanted patients show a comparable hypercoagulable state prior to kidney transplantation compared to living kidney donors.

Nieuwenhuijs-Moeke, G. J., van den Berg, T. A. J. et al.

PLoS ONE 2018;13(7):e0200537.


Aims
To determine whether there is a difference in haemostatic state between pre-emptively and non-pre-emptively transplanted patients.

Interventions
None – this is a post-hoc observational analysis of patients in the VAPOR-1 study.

Participants
57 kidney donor recipients from the VAPOR-1 trial. Of these, 28 were transplanted pre-emptively and 29 were transplanted non-preemptively.

Outcomes
The main outcome being measured in this study was haemostatic state of transplant patients by measuring coagulation and platlet activation. Aside from this, the levels of thrombin, von-Willebrand factor, clot lysis and reperfusion pathology were measured to assess the haemostatic state of preemptive and non-preemptive patients.

Follow-up
2 years

CET Conclusions
In many renal transplant centres, anti-coagulation protocols differ between pre-emptive and dialysing recipients in the belief that pre-emptive recipients have an increased risk of thrombosis compared to those on dialysis. The authors of this manuscript investigate this assumption using a retrospective analysis of samples from the VAPOR-1 study. They find that both pre-emptive and non-preemptive recipients have a hypercoagulable pre-transplant state compared to healthy living donors, with no difference between the two groups. These results suggest that there is no rationale for differential treatment of recipients depending on dialysis status at the time of transplantation. Whether the use of a single dose of unfractionated heparin prior to vessel clamping, as used in many centres, has a significant impact on thrombosis risk would require further prospective study.

Jadad score
4

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
ClinicalTrials.gov - NCT01248871

Funding source
Non-industry funded