Pawlicki J, Cierpka L, Król R, Ziaja J
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2011 Oct;43(8):3013-7. doi: 10.1016/j.transproceed.2011.07.018.
Clotting disturbances resulting from chronic renal failure do not remit immediately after successful kidney transplantation (KTx). Hemorrhagic and thrombotic complications after KTx increase the risk of transplanted kidney loss. The aim of the study was to analyze the influence of clotting system disturbances and applied antithrombotic prophylaxis on the development of hemorrhagic and thrombotic complications among KTx patients in the early postoperative period.
Sixty seven KTx patients underwent measurement of plasma activated partial thromboplastin time (APTT); international normalized ratio; fibrinogen and D-dimer concentration; activity of antitrombin III; protein C and S, VIII, IX; and von Willebrand factors, as well as platelet counts.
A perigraft hematoma developed in 25.4% patients, of whom 4.5% required reoperation. Lower antithrombin III activity (96.2±27.6 vs 112.3±17.4, P=.02) on postoperative day (POD) 7 and higher fibrinogen concentration (4.41±2.03 vs 3.35±0.87, P=.01) and platelet count (269.8±117.5 vs 215.8±64.8, P=.03) on POD 14 were noted in recipients with a hematoma compared to those free of this complication. A perigraft hematoma developed in 57.9% patients undergoing antithrombotic prophylaxis and in 12.5% without this treatment (P=.0002). Among patients receiving unfractionated heparin, we observed extension of APTT on POD 1 (45.9±53.2 vs 30.9±7.5 seconds, P=.04), higher von Willebrand factor activity on POD 7 (348.8±122.2 vs 218.5±125.5, P=.02), and higher D-dimer concentrations POD 7 and 14 (1662±894 vs 757±708, P=.002 and 1614±1372 vs 672±532, P=.003, respectively). No significant differences were observed as regards to analyzed parameters between patients receiving low-molecular-weight heparin versus those not receiving antithrombotic prophylaxis.
Disturbances in analyzed parameters of hemostasis did not increase the risk of hemorrhagic and thrombotic complications in the early period after KTx. Antithrombotic prophylaxis increases the risk of hemorrhagic complications and should be introduced only for selected renal transplant recipients.
慢性肾衰竭导致的凝血功能紊乱在成功进行肾移植（KTx）后不会立即缓解。肾移植后的出血和血栓形成并发症会增加移植肾丢失的风险。本研究的目的是分析凝血系统紊乱及应用抗血栓预防措施对肾移植患者术后早期出血和血栓形成并发症发生发展的影响。
67例肾移植患者接受了血浆活化部分凝血活酶时间（APTT）、国际标准化比值、纤维蛋白原和D - 二聚体浓度、抗凝血酶III活性、蛋白C和S、VIII、IX以及血管性血友病因子的检测，同时检测了血小板计数。
25.4%的患者发生了移植肾周血肿，其中4.5%需要再次手术。与无此并发症的受者相比，发生血肿的受者在术后第7天抗凝血酶III活性较低（96.2±27.6对112.3±17.4，P = 0.02），在术后第14天纤维蛋白原浓度较高（4.41±2.03对3.35±0.87，P = 0.01）以及血小板计数较高（269.8±117.5对215.8±64.8，P = 0.03）。接受抗血栓预防的患者中有57.9%发生了移植肾周血肿，未接受该治疗的患者中有12.5%发生了移植肾周血肿（P = 0.0002）。在接受普通肝素治疗的患者中，我们观察到术后第1天APTT延长（45.9±53.2对30.9±7.5秒，P = 0.04），术后第7天血管性血友病因子活性较高（348.8±122.2对218.5±125.5，P = 0.02），以及术后第7天和第14天D - 二聚体浓度较高（分别为1662±894对757±708，P = 0.002和1614±1372对672±532，P = 0.003）。接受低分子量肝素治疗的患者与未接受抗血栓预防治疗的患者在分析参数方面未观察到显著差异。
止血分析参数的紊乱在肾移植术后早期并未增加出血和血栓形成并发症的风险。抗血栓预防增加了出血并发症的风险，应仅对选定的肾移植受者采用。
