Benefits of Anticoagulation Prophylaxis in Children Undergoing Kidney Transplant: Systematic Review and Meta-Analysis.
Al-Huniti, A. H., et al.Journal of Thrombosis & Haemostasis 2025 [record in progress].
Aims
This study aimed to assess the role of thromboprophylaxis for preventing kidney graft thrombosis among pediatric kidney transplant patients ≤ 21 years.
Interventions
Three databases including MEDLINE, Embase, and Cochrane Libraries were searched for literature. Screening of titles and abstracts, and data extraction were performed by two independent reviewers. The National Institutes of Health Quality Assessment of Controlled Intervention Studies was used to assess the risk of bias in randomised and nonrandomised/quasi-randomised studies, and the National Institutes of Health Quality Assessment Tool was used for observational cohort and cross-sectional studies.
Participants
25 studies were included in the paper.
Outcomes
The primary endpoint was graft thrombosis. The secondary endpoint was major bleeding.
Follow-up
N/A
CET Conclusions
This paper reports on an interesting systematic review. The review was conducted with a broad search strategy and across multiple databases, including studies published in all languages. Articles were screened in duplicate, and data was extracted in duplicate to increase validity. Twenty-five studies were included. None of the studies were randomised, they were all observational, but included a good number of patients (over 2000). The most commonly used single agent was unfractionated heparin, followed by low molecular weight heparin, followed by aspirin. In fewer than 1% of cases dipyridamole was used. 49% of the patients received a combination of medications. There was a preponderance for the use of thromboprophylaxis in higher risk cases, despite this, the review found a significant reduction in graft thrombosis with preventative pharmaceutical measures, using meta-analysis of comparative studies (OR for thrombosis= 0.31). The pooled risk of thrombosis in all patients given prophylaxis was 2.4% (non-comparative studies) to 3.9% (comparative studies). In the standard care group, the risk of thrombosis was as high as 12%. Importantly the use of thromboprophylaxis was not associated with increased risk of bleeding. The risk of graft loss due to major bleeding was very low in this study (less than 1%). When graft-associated thrombosis did occur, the risk of losing the graft was high (96-98%), regardless of prophylaxis. There was a large array of prophylaxis regimens and doses used across all the studies. Sensitivity analysis was undertaken but should be considered carefully. This breakdown indicated that higher dose prophylaxis was no more effective than standard dose. The duration of prophylaxis used also varied considerably. This paper therefore is very supportive of using some form thromboprophylaxis in paediatric renal transplantation, however the best exact regimen, drug and duration cannot be defined by this review.
Trial registration
PROSPERO - CRD42020166727