Intraoperative unfractionated heparin (UFH) for kidney transplantation: A systematic review and meta-analysis.
Singla, A., et al.Transplant Rev (Orlando). 2026 Jan;40(1):100985.
Aims
The main aim of the study was to systematically compile and evaluate existing evidence on the role of intraoperative intravenous unfractionated heparin (UFH) use in adult kidney transplant recipients.
Interventions
MEDLINE, Embase, and CENTRAL databases were used to search for literature. Studies were selected and data were extracted by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias.
Participants
3 studies were included in the review.
Outcomes
Primary outcome: Incidence of thrombotic complications Secondary outcomes: Bleeding complications, incidence of delayed graft function and graft loss and transplant nephrectomy.
Follow-up
N/A
CET Conclusions
Intraoperative administration of unfractionated heparin (UFH) is a routine practice in many kidney transplant (KT) centres, despite a lack of strong evidence to support its use to prevent renal arterial or venous thrombosis. This systematic review synthesised the available evidence assessing the efficacy and risk associated with intraoperative UFH use in KT. The primary outcome was rate of thrombotic complications, including renal arterial or venous thrombosis. Secondary outcomes included the rates of bleeding complications, delayed graft function (DGF) and graft loss. Only 3 retrospective studies were included in the analysis with a total of 1989 participants. There was no improvement in the rate of thrombotic complications, DGF or graft loss associated with intraoperative UFH. The overall rate of thrombotic complications was 2.3%, in keeping with previous literature. In addition to the retrospective nature of the included studies, important potential confounding factors were not considered. For example, the details of anti-coagulation and/or anti-platelet therapy in the immediate post-operative period was not included in the analysis. This systematic review thus failed to demonstrate a treatment effect of UFH. With multiple other studies and reviews (including a Cochrane review) showing similar results, a randomised trial is urgently needed to assess the validity of this longstanding practice.
Trial registration
PROSPERO - CRD42023391473