Department of Urology, Rouen University Hospital, Rouen, France.
Department of Nephrology, Rouen University Hospital, Rouen, France.
Prog Urol. 2021 Jun-Jul;31(8-9):531-538. doi: 10.1016/j.purol.2020.12.007. Epub 2021 Jan 27.
The standard treatment for end-stage renal disease is renal transplantation. As vascular anastomoses are performed during the surgery, it may expose to a risk of vascular thrombosis. This raises the question of using intravenous heparin during the procedure. The purpose of this study was to compare the incidence of renal transplant vascular thrombosis in the perioperative period based on whether the patients received or not intraoperative heparin.
A single center retrospective study was conducted on a cohort of consecutive patients who underwent renal transplantation between 2011 and 2015. Patients were divided into two groups: patients not receiving heparin vs. receiving heparin at the dose of 0.5mg/kg. A Doppler ultrasound was performed at day one postoperatively to assess the occurrence of vascular thrombosis. Hemorrhagic complications and the need for postoperative transfusion were also assessed.
In total, 261 patients were included. Fifty-one patients received heparin (19.5%). Patient's baseline characteristics were comparable between the groups. No significant difference was found regarding the incidence of vascular thrombosis (6% for both groups, P=1). In addition, no difference was found regarding hemorrhagic complications requiring surgical revision (P=1) as well as early postoperative transfusion rate (P=0.57).
Our results suggest that intraoperative IV heparin doesn't improve the risk of vascular thrombosis following renal transplantation. However, intraoperative IV heparin was not significantly associated with a higher rate of hemorrhagic complications suggesting that heparin can be safely used if required in some selected patients at higher risk of thrombosis.
终末期肾病的标准治疗方法是肾移植。由于手术过程中需要进行血管吻合，因此存在血管血栓形成的风险。这就提出了在手术过程中是否使用静脉内肝素的问题。本研究的目的是比较根据患者是否接受术中肝素治疗，在围手术期发生肾移植血管血栓形成的发生率。
对 2011 年至 2015 年间连续接受肾移植的患者进行了单中心回顾性研究。患者分为两组：未接受肝素组和接受 0.5mg/kg 肝素组。术后第一天进行多普勒超声检查以评估血管血栓形成的发生。还评估了出血并发症和术后输血的需求。
共纳入 261 例患者。51 例患者接受肝素治疗（19.5％）。两组患者的基线特征无差异。血管血栓形成的发生率（两组均为 6％，P=1）无显著差异。此外，需要手术修正的出血并发症（P=1）以及术后早期输血率（P=0.57）也无差异。
我们的结果表明，术中 IV 肝素并不能增加肾移植后血管血栓形成的风险。但是，术中 IV 肝素与出血并发症的发生率增加无关，这表明如果某些高血栓形成风险的选定患者需要肝素，可以安全使用肝素。
3 级。
