Hemostatic Complications in Renal Transplantation

Chronic kidney disease (CKD) represents the irreversible loss of the excretory and homeostatic functions of the kidney. Renal transplantation is the preferred treatment for patients with advanced CKD. Despite the availability of more effective immunosuppressive drugs and the improvements in surgical techniques, the development of complications can compromise early and long-term outcomes of renal transplantation. In particular, bleeding and thrombotic disorders can have impact on patient and graft survival. Risk stratification, early diagnosis, and appropriate interventions are critical to the management of these complications. Renal arterial and vein thrombosis are the most common vascular complications in the early phase after transplantation, whereas renal artery stenosis is a late event mainly related to surgery. Standard heparin thromboprophylaxis should be adopted in the perioperative period. Among renal transplant recipients, a high risk of venous thromboembolism (VTE) is reported. This risk persists long after transplantation, and patients with a previous episode of VTE are also at high risk for recurrence. An extended anticoagulant treatment should be considered, balancing the bleeding risk in a given patient. To date, the use of vitamin K antagonists remains preferred, given the risk of pharmacological interference with immunosuppressive agents and the renal metabolism of direct oral anticoagulants. In this review, bleeding and thrombotic complications of renal transplantation are described, and recommended thromboprophylaxis is discussed.