Journal List > J Korean Soc Transplant > v.24(1) > 1034310

Hwang, Kim, Park, Kim, and Moon: Symptomatic Lower Extremity Deep Vein Thrombosis after Kidney Transplantation: a 40-Year Single Center Experience in Korea

Abstract

Background

It is well known that kidney transplant recipients in Western countries are at high risk for development of lower extremity (LE) deep vein thrombosis (DVT). The aim of this study was to establish the frequency of symptomatic LE DVT, the time until their occurrence, and to define risk factors for them following kidney transplantation (KT) in Korea.

Methods

We performed a retrospective analysis of LE DVT among 1695 patients who were kidney transplant recipients between 1969 and 2009. All patients were symptomatic with objective diagnostic modalities. Results were compared with those for a cohort of kidney transplant recipients from the same center without DVT.

Results

During follow-up, 21 symptomatic LE DVTs (1.2%) occurred in 18 patients (1.1%). The mean interval between transplantation and a first episode of DVT was 77.1±76.6 months. No DVT episode developed within one month after KT. There were no significant differences in body mass index, graft function, donor age and sex, recipient sex, type of preoperative renal replacement therapy, immunosuppressive agents, and malignancy between the two groups. Patients who developed LE DVT had a significantly different recipient age, presence of diabetes mellitus, presence of acute rejection episodes, and type of donor (P<0.05).

Conclusions

Our retrospective study showed that the incidence of LE symptomatic DVT after KT is lower than after other surgeries performed in Korean hospitals and after KT performed in Western countries. There were no cases of symptomatic DVT within 1 month after KT. Our findings suggest that aggressive DVT prevention is not necessary for KT recipients in Korea.

References

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Fig. 1.
Time of occurrence of the first deep vein thrombosis following renal transplantation.
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Table 1.
Characteristics of patients investigated
  All patients (n=1,695) Control group (n=1,677) DVT group (n=18) P value
Recipient age, years (mean±SD) 37.7±10.8 37.6±10.8 42.2±7.6 <0.05
Recipient sex, male 1,109 (65.4%) 1,097 (65.4%) 12 (66.7%) NS
Donor age, years (mean±SD) 38.4±12.6 38.4±12.6 39.7±16.0 NS
Donor sex, male 979 (57.8%) 968 (57.8%) 11 (61.1%) NS
BMI, kg/m2 (mean±SD) 21.5±3.1 21.5±3.1 23.3±2.5 NS
Acute rejection episode, ≥1 295 284 (16.9%) 11 (61.1%) <0.05
Type of donor, cadaver 209 203 (12.1%) 6 (33.3%) <0.05
Diabetes mellitus 488 478 (28.5%) 10 (55.6%) <0.05
Graft function, functioning 1,203 1,187 (70.8%) 16 (88.9%) NS
Mismatching numbers of HLA 2.9±1.4 2.9±1.4 2.6±1.5 NS
Malignancy 136 134 (8.0%) 2 (11.1%) NS
Preoperative RRT       NS
Hemodialysis 1,272 1,260 (75.1%) 12 (66.7%)  
Peritoneal dialysis 260 255 (15.2%) 5 (27.8%)  

Abbreviations: BMI, body mass index; RRT, renal replacement therapy; NS, not significant; HLA, human leukocyte antigen.

Table 2.
Treatment methods and results of deep vein thrombosis
No Age/Sex Risk factors Interval (months) Side of DVT Location of DVT a Treatment Duration of anticoagulation Recurrence
1 68/Male Cancer 332.9 Same CFV Anticoagulation 12 months No
2 50/Female Bedridden 148.0 Same CFV Anticoagulation 6 months No
3 44/Female Bedridden 10.2 Same PV Anticoagulation 6 months No
4 48/Male No 116.3 Controlateral PV Anticoagulation 3 months No
5 45/Male No 10.9 Same CFV Anticoagulation 6 months No
6 65/Male Operation 101.9 Controlateral CFV Anticoagulation 6 months No
7 39/Male No 26.7 Controlateral PV Anticoagulation 3 months No
8 50/Male No 62.3 Controlateral SFV Anticoagulation 6 months Yes
9 65/Female No 95.5 Controlateral PV Anticoagulation 3 months No
10 36/Female Bedridden 8.3 Controlateral CFV Anticoagulation 6 months No
11 42/Male No 75.7 Controlateral PV Anticoagulation 3 months No
12 69/Female Cancer 146.4 Same EIV Thrombectomy, anticoagulation 6 months No
13 63/Male No 103.1 Same EIV Thrombectomy, anticoagulation 6 months No
14 37/Male No 11.4 Controlateral CFV Anticoagulation, IVC filter 1 month Yes
15 39/Male Operation 1.4 Controlateral CFV Anticoagulation 6 months No
16 39/Male Bedridden 27.3 Controlateral PV Anticoagulation 3 months No
17 30/Male No 12.0 Controlateral CIV Anticoagulation 9 months No
18 53/Female Operation 41.3 Controlateral CFV Anticoagulation 6 months No

Abbreviations: DVT, deep vein thrombosis; CFV, common femoral vein; PV, popliteal vein; SFV, superficial femoral vein; EIV, external iliac vein; CIV, common iliac vein.

Table 3.
Summary of reported series of lower extremity deep vein thrombosis in renal transplant recipients
Authors (reference number) Year Study design Total patients (n) DVT patients (n) (%) Prophylaxis Recurrence
Butt et al (4) 1975 Retrospective 218 10 (4.6%) No N/A
Joffe (5) 1976 Prospective 7 4 (57.1%) No N/A
Venkateswara et al (6) 1976 Retrospective 100 10 (10.0%) No N/A
Arnadottir et al (7) 1983 Retrospective 125 10 (8.0%) No N/A
Bergqvist et al (8) 1985 Prospective 83 20 (24.1%) No 40%
Vanrenterghem et al (9) 1985 Retrospective 180 3 (1.7%) No N/A
Allen et al (10) 1987 Retrospective 480 36 (7.5%) No N/A
Gruber et al (11) 1987 Prospective 224 4 (1.8%) N/A N/A
Vachharajani et al (12) 1997 Retrospective 299 9 (3.0%) N/A 56%
Humar et al (13) 1998 Retrospective 1,833 82 (4.5%) No 22%
Park et al (16) 2000 Retrospective 1,658 7 (0.4%) N/A N/A
Poli et al (14) 2006 Prospective 518 43 (83%) Yes 47%
Derweesh et al (15) 2008 Prospective 165 16 (9.7%) N/A N/A
Present study 2009 Retrospective 1,695 18 (1.1%) No 11%

Abbreviations: N/A, not available; DVT, deep vein thrombosis.

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