The epidemiology of early deep vein thrombosis in kidney transplant recipients

Kidney transplantation is the treatment of choice for end-stage renal disease, offering recipients improved survival and quality of life compared with dialysis. However, kidney transplant recipients (KTRs) are 7 to [...]
Background: Because kidney transplant recipients may be at increased risk for deep vein thrombosis (DVT) following transplantation, we investigated the incidence, risk factors, treatments and outcomes of early DVT among kidney transplant recipients. Methods: An observational, single-centre cohort study was conducted among adult kidney transplant recipients from Jan. 1, 2005, to Dec. 31, 2016 with 1-year followup. Time to DVT was assessed using the Kaplan-Meier method. Cox proportional hazards and linear regression models were used to analyze risk factors for and outcomes of DVT. Results: The cumulative incidence of DVT was 4.25% at 3 months after transplant. In multivariable analysis, the use of depleting induction agents (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.05-4.35]), white recipient race (HR 1.84. 95% CI 1.08-3.12), the use of kidneys from expanded criteria donors (HR 2.13, 95% CI 1.05-4.32) and lower recipient body mass index (HR 0.95, 95% CI 0.91-1.00) increased the risk for early DVT. Peritransplant DVT prophylaxis was not associated with early DVT. Early DVT was not associated with reduced graft function, death, graft failure or first hospital readmission. Conclusion: Risk factors for early DVT in our cohort of kidney transplant recipients included white recipient race, use of depleting agents, lower recipient body mass index and use of expanded criteria donors. As practice patterns of donor and recipient selection in kidney transplantation evolve, the results of this study may aid in perioperative risk assessments and decision-making about the use of DVT prophylaxis. Contexte : Etant donne que les receveurs de transplantation renale peuvent etre exposes a un risque accru de thrombose veineuse profonde (TVP) apres l'intervention, nous avons voulu examiner l'incidence, les facteurs de risque, les traitements et l'issue de la TVP precoce chez les receveurs de transplantation renale. Methodes : Nous avons procede a une etude de cohorte observationnelle monocentrique aupres d'adultes ayant subi une transplantation renale entre le 1 (er) janvier 2005 et le 31 decembre 2016, suivis pendant 1 an. L'intervalle avant la TVP a ete evalue par la methode de Kaplan-Meier. Des modeles d'analyse a risques proportionnels de Cox et la regression lineaire ont servi pour l'analyse des facteurs de risque et l'issue de la TVP. Resultats : L'incidence cumulative des TVP etait de 4,25 % 3 mois apres la transplantation. Dans l'analyse multivariee, l'utilisation d'agents d'induction antirejet (risque relatif [RR] 2,13, intervalle de confance [IC] de 95 % 1,05-4,35]), des receveurs de race blanche (RR 1,84, IC de 95 % 1,08-3,12), l'utilisation de greffons renaux provenant de donneurs a criteres elargis (RR 2,13, IC de 95 % 1,05-4,32) et un indice de masse corporel (IMC) moindre chez les receveurs (RR 0,95, IC de 95 % 0,91-1,00) ont fait augmenter le risque de TVP precoce. La prophylaxie anti-TVP entourant l'intervention n'a pas ete associee a la TVP precoce. La TVP precoce n'a pas ete associee a une diminution du fonctionnement du greffon, au deces, a la defaillance du greffon, ni a la premiere rehospitalisation. Conclusion : Dans notre cohorte de greffes du rein, les facteurs de risque de TVP precoce incluaient race blanche des receveurs, utilisation d'agents antirejet, IMC moindre des receveurs et donneurs a criteres elargis. A mesure qu'evolueront les principes de selection des donneurs et des receveurs pour la transplantation renale, les resultats de cette etude pourraient aider a evaluer le risque peri-operatoire et a eclairer les prises de decision entourant la prophylaxie anti-TVP.