Bleeding and Thrombosis in High-Risk Renal Transplantation Candidates Using Heparin

In renal transplant recipients, the incidence of early post-transplant renal vascular complications varies from 6 % to 30%. Among these complications, thrombosis of the renal artery or vein frequently leads to immediate graft loss.1 Thrombotic events occur in up to 10 % of adult and 12 % of pediatric kidney transplant recipients.2,3 Thrombosis gener-ally develops within 48 hours after the transplant proce-dure, but can occur up to 14 days later.4 Numerous risk factors have been reported to increase the likelihood of thrombotic graft loss.5 Prominent factors are genetic and acquired hypercoagulable states (HCS) such as activated protein C resistance (factor V leiden muta-tion), antithrombin III deficiency, protein C or S deficiency, antiphospholipid or anticardiolipin antibody, homocysteine elevation, and prothrombin gene mutation.4,5 Additional fac-tors include age extremes, certain immunosuppressive medi-cations, donor type, dialysis modality prior to transplanta-tion, prior transplant procedures, and surgical technique.4,6 Anticoagulation can reduce the risk of renal thrombosis and improve early graft survival in high-risk patients.6,7 In one study, perioperative administration of heparin to pa