Abstract | BACKGROUND: METHODS: To prevent clotting, donor kidneys were perfused with an HTK/ heparin solution with heparin washed out immediately pretransplantation. However, in 4/14 recipients, significant postoperative diffuse hemorrhage occurred with the need for surgical intervention in 3 patients. To analyze the cause of postoperative diffuse bleeding, sequentially before and after opening the graft anastomosis, we prospectively performed coagulation studies: partial thromboplastin time (PTT), thrombin time, thromboplastin time, fibrinogen, antithrombin, D-dimers, plasminogen, and thrombelastography. RESULTS: We found no clotting disturbances owing to blood group-specific immunoadsorption. However, 3/4 patients with bleeding complications showed elevated PTT values even 2 hours after opening the anastomosis, which was proven to be a heparin effect by in vitro application of heparinase. Hyperfibrinolysis and disturbances of platelet aggregation were not detected. Because of these results, we lowered the heparin dose administered after donor nephrectomy from initially 10,000-20,000 to 4000 IU resulting in significantly lower PTT values at 2 hours (34.6 ± 4.5 s among patients 6-14 vs 69.0 ± 16.3 s among patients 1-5; P = .012). There were no further bleeding complications. Lowering the heparin dosage had no impact on graft function: serum creatinine at discharge of 1.5 ± 0.1 versus 1.6 ± 0.2 mg/dL. CONCLUSION:
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Authors | F C Renner, B Czekalinska, B Kemkes-Matthes, A Feustel, W A Stertmann, W Padberg, R Weimer |
Journal | Transplantation proceedings
(Transplant Proc)
Vol. 42
Issue 10
Pg. 4164-6
(Dec 2010)
ISSN: 1873-2623 [Electronic] United States |
PMID | 21168653
(Publication Type: Journal Article)
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Copyright | Copyright © 2010 Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- ABO Blood-Group System
- Blood Group Incompatibility
- Blood Loss, Surgical
- Humans
- Kidney Transplantation
(adverse effects)
- Living Donors
- Prospective Studies
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