Department of General Surgery and Transplantology, Pomeranian Medical University, Szczecin, Poland; Department of Normal and Clinical Anatomy, Pomeranian Medical University, Szczecin, Poland.
Transplant Proc. 2021 Jun;53(5):1562-1569. doi: 10.1016/j.transproceed.2021.03.011. Epub 2021 Apr 21.
Endothelial disturbance is well known as one of the causes of thrombosis. This study measured von Willebrand factor (vWF) and soluble thrombomodulin (sTM) in renal vein blood to evaluate for the risk of thrombosis after kidney transplantation.
A cross-sectional study that included 61 consecutive recipients of kidney transplant. The sTM and activity of vWF were evaluated in blood of the renal vein at the time of reperfusion.
The renal vein blood had higher values of vWF activity and sTM concentration than the peripheral blood. In the first minutes of reperfusion, the concentration of thrombomodulin was the highest but activity of vWF was the lowest. As the reperfusion continued, thrombomodulin gradually decreased, but vWF increased. The strong correlations of TMs and vWF with warm ischemia were observed (r = 0.5577 and r = 0.3429, respectively). Thrombosis was found in about 10% of all recipients. However, other complications, such as delayed graft function or ureter necrosis, were associated with high values of vWF and sTM. They were correlated with increased sTM concentration and activity of vWF (P < .006 and P < .05, respectively). This was confirmed by analysis of the receiver operator characteristic curve. The area under the curve values for TMs and vWF were 0.762 and 0.602, respectively (P < .0001 and P < .015, respectively). The cutoff points for sTM and vWF were 14.89 ng/mL and 129.89%, respectively. Positive prediction value sTM and vWF were 76% and 66% and negative prediction value 69% and 59%, respectively.
The endothelium of a transplanted kidney could be involved in the pathogenesis of renal thrombosis. Endothelial protection during harvesting can greatly contribute to the improvement of transplantation outcomes. The renal pool of sTM and vWF could be a useful marker of the risk of renal thrombosis.
血管内皮功能紊乱是血栓形成的原因之一。本研究通过测量肾静脉血中血管性血友病因子（vWF）和可溶性血栓调节蛋白（sTM），评估肾移植后血栓形成的风险。
这是一项横断面研究，共纳入 61 例连续接受肾移植的患者。在再灌注时评估肾静脉血中 sTM 和 vWF 的活性。
肾静脉血中 vWF 活性和 sTM 浓度均高于外周血。再灌注的最初几分钟，血栓调节蛋白浓度最高，而 vWF 活性最低。随着再灌注的继续，血栓调节蛋白逐渐下降，而 vWF 增加。TMs 和 vWF 与热缺血之间存在很强的相关性（r 分别为 0.5577 和 0.3429）。发现约 10%的受者发生血栓形成。然而，其他并发症，如移植肾功能延迟恢复或输尿管坏死，与 vWF 和 sTM 浓度升高有关。它们与 sTM 浓度增加和 vWF 活性升高相关（P<0.006 和 P<0.05）。这通过分析受试者工作特征曲线得到了证实。TMs 和 vWF 的曲线下面积值分别为 0.762 和 0.602（P<0.0001 和 P<0.015）。sTM 和 vWF 的截断值分别为 14.89ng/mL 和 129.89%。sTM 和 vWF 的阳性预测值分别为 76%和 66%，阴性预测值分别为 69%和 59%。
移植肾的内皮可能参与了肾血栓形成的发病机制。在采集过程中对内皮的保护可以极大地改善移植结果。sTM 和 vWF 的肾池可能是肾血栓形成风险的有用标志物。
