Anticoagulation after renal transplantation: a multicenter survey on clinical practice

Objectives. - Graft thrombosis is a major complication of transplantation. However, there are no recommendation on immediate postoperative thromboprophylaxis after kidney transplantation. We recorded clinical practices in France. Material and Methods. - In 29 transplantation centres, four case studies were submitted to the medical kidney transplantation referent (compatible graft from cadaveric donor, without perioperative complication). N degrees 1: Man, 27-years-old, IgA glomerulonephritis, without history of hypercoagulability or cardiovascular risk factor. Hemodialysis since 12 months. N degrees 2: Man, 53-years-old, with history of deep venous thrombosis after cholecystectomy 15 years before. Membranous nephropathy. Hemodialysis since 10 months. N degrees 3: Man, 58-years-old, with history of myocardial infarction. On aspirin therapy. Nephroangiosclerosis and diabetic nephropathy. Peritoneal. dialysis since 6 months. N degrees 4: Woman, 63-years-old. Atrial. fibrillation on vitamin K antagonists therapy. Lupus nephritis without anti phospholipid syndrome. Hemodialysis since 12 months. Results. - N degrees 1: No anticoagulation therapy (62%), calcium heparin at prophylactic doses (34.5%). N degrees 2: No anticoagulation therapy (38%), calcium heparin at prophylactic doses (44.8%). N degrees 3: 62% interrupted aspirin of whom 22% without any immediate anticoagulation and 55% replaced aspirin with calcium heparin at prophylactic doses. Thirty-eight percent carried on with aspirin of whom 63.6% without other prophylaxis and 27.3% in association with calcium heparin at prophylactic doses. N degrees 4: Unfractionned heparin at curative dose (62%), unfractionned heparin at prophylactic doses (17.2%), calcium heparin at prophylactic doses (13.8%). Conclusion. - Postoperative anticoagulation after renal transplantation is established as a local dogma rather than evidence-based medicine. Guideline recommendations and standardized protocols for the use of anticoagulation after kidney transplantation should be developed. (c) 2008 Elsevier Masson SAS. All rights reserved.