Kidney retransplants after initial graft loss to vascular thrombosis

Background: Vascular thrombosis early after a kidney transplant is an infrequent but devastating complication. Often, no cause is found. These recipients are generally felt to be good candidates for a retransplant. However, their ideal care at the time of the retransplant and their outcomes have not been well documented. We studied outcomes in 16 retransplant recipients who had lost their first graft early posttransplant (<1 month) to vascular thrombosis. 
Methods: Of 2 003 kidney transplants between 1 January 1984 and 30 September 1998, we identified 32 recipients who had lost their first graft early posttransplant to vascular thrombosis. Of these 32 recipients, 16 were subsequently retransplanted and detailed chart reviews were done. 
Results: Of the 16 retransplant recipients, 12 lost their first graft to renal vein thrombosis and 4 to renal artery thrombosis. Thrombosis generally occurred early (mean, 3.6 d). Five recipients underwent a complete hematologic workup to rule out a thrombophilic disorder before their retransplant: 4 had a positive result (presence of antiphospholipid antibodies, n=3; increased homocysteine levels, n=1). These 4 recipients, along with 1 other recipient who had a strong family history of thrombosis, underwent thrombosis prophylaxis at the time of their retransplant. Prophylaxis consisted of low‐dose heparin for the first 3–5 d posttransplant, followed by acetylsalicylic acid or Coumadin. 
Of the 16 retransplant recipients, none developed thrombosis. Of the 5 who underwent thrombosis prophylaxis, none had significant bleeding complications. At a mean follow‐up of 5.4 yr, 10 (63%) recipients have functioning grafts. Causes of graft loss in the remaining 6 recipients were death with function (n=5, 31%) and acute rejection (n=1, 6%). Graft and patient survival rates after these 16 retransplants were equivalent to results after primary transplants. The incidence of acute and chronic rejection was also no different (p=ns). 
Conclusion: Vascular thrombosis in the absence of obvious technical factors should prompt a workup for a thrombophilic disorder before a retransplant. Recipients with an identified disorder should undergo prophylaxis at the time of the retransplant. Results in these retransplant recipients are equivalent to those seen in primary transplant recipients.

[1]  C. Mackworth-Young,et al.  Primary Antiphospholipid Syndrome , 2006 .

[2]  D. Dunn,et al.  Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection. , 1999, Annals of surgery.

[3]  B. Tönshoff,et al.  Heterozygous prothrombin gene mutation: a new risk factor for early renal allograft thrombosis. , 1999, Transplantation.

[4]  J. Mcintyre,et al.  Antiphospholipid antibodies are a risk factor for early renal allograft failure. , 1999, Transplantation.

[5]  D. Wagenknecht,et al.  Antiphospholipid antibodies are a risk factor for early renal allograft failure: isolation of antiphospholipid antibodies from a thrombosed renal allograft. , 1999, Transplantation proceedings.

[6]  R. Kandaswamy,et al.  Vascular graft thrombosis after pancreas transplantation: comparison of the FK 506 and cyclosporine eras. , 1999, Transplantation proceedings.

[7]  M. Fischereder,et al.  Early loss of renal transplants in patients with thrombophilia. , 1998, Transplantation.

[8]  P. Morris,et al.  The factor V Leiden (R506Q) mutation and risk of thrombosis in renal transplant recipients. , 1997, Transplantation.

[9]  Anup Singh,et al.  Risk factors for vascular thrombosis in pediatric renal transplantation: a special report of the North American Pediatric Renal Transplant Cooperative Study. , 1997, Transplantation.

[10]  D. Hollomby,et al.  Salvage of a renal allograft with renal vein occlusion secondary to extrinsic compression. , 1996, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  M. Christiaans,et al.  Renal graft thrombosis. , 1995, Transplantation.

[12]  K. Byth,et al.  Renal graft thrombosis. A survey of 134 consecutive cases. , 1994, Transplantation.

[13]  A. Hoitsma,et al.  Early vascular complications of renal transplantation , 1993 .

[14]  D. Dunn,et al.  Causes of Renal Allograft Loss: Progress in the 1980s, Challenges for the 1990s , 1991, Annals of surgery.

[15]  D. Dunn,et al.  Causes of renal allograft loss , 1991 .

[16]  D. Dunn,et al.  Lessons learned and future hopes: three thousand renal transplants at the University of Minnesota. , 1990, Clinical transplants.

[17]  G. Hughes,et al.  The “Primary” Antiphospholipid Syndrome: Major Clinical and Serological Features , 1989, Medicine.

[18]  B. Chavers,et al.  ALLOGRAFT RENAL VASCULAR THROMBOSIS‐LACK OF INCREASE WITH CYCLOSPORINE IMMUNOSUPPRESSION , 1989, Transplantation.