Original Report: Transplantation
Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant RecipientsLam N.N.a · Garg A.X.b,c,g · Knoll G.A.d, e · Kim S.J.f, g · Lentine K.L.i, j · McArthur E.g · Naylor K.L.g, h · Bota S.E.g · Sood M.M.d,e,g
aDepartment of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, bDepartment of Medicine, Division of Nephrology, Western University, and cDepartment of Epidemiology and Biostatistics, Western University, London, ON, dDepartment of Medicine, Division of Nephrology, University of Ottawa, and eClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, fDepartment of Medicine, Division of Nephrology, University of Toronto, gInstitute for Clinical Evaluative Sciences (ICES), and hInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; iCenter for Abdominal Transplantation, Saint Louis University, and jDepartment of Medicine, Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO, USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: The implications of venous thromboembolism (VTE) for morbidity and mortality in kidney transplant recipients are not well described. Methods: We conducted a retrospective study using linked healthcare databases in Ontario, Canada to determine the risk and complications of VTE in kidney transplant recipients from 2003 to 2013. We compared the incidence rate of VTE in recipients (n = 4,343) and a matched (1:4) sample of the general population (n = 17,372). For recipients with evidence of a VTE posttransplant, we compared adverse clinical outcomes (death, graft loss) to matched (1:2) recipients without evidence of a VTE posttransplant. Results: During a median follow-up of 5.2 years, 388 (8.9%) recipients developed a VTE compared to 254 (1.5%) in the matched general population (16.3 vs. 2.4 events per 1,000 person-years; hazard ratio [HR] 7.1, 95% CI 6.0-8.4; p < 0.0001). Recipients who experienced a posttransplant VTE had a higher risk of death (28.5 vs. 11.2%; HR 4.1, 95% CI 2.9-5.8; p < 0.0001) and death-censored graft loss (13.1 vs. 7.5%; HR 2.3, 95% CI 1.4-3.6; p = 0.0006) compared to matched recipients who did not experience a posttransplant VTE. Conclusions: Kidney transplant recipients have a sevenfold higher risk of VTE compared to the general population with VTE conferring an increased risk of death and graft loss.
© 2017 S. Karger AG, Basel
- Puurunen MK, Gona PN, Larson MG, Murabito JM, Magnani JW, O'Donnell CJ: Epidemiology of venous thromboembolism in the Framingham Heart Study. Thromb Res 2016;145:27-33.
- Küpeli E, Ulubay G, Doğrul I, Birben Ö, Seyfettin P, Özsancak Uğurlu A, et al: Long-term risk of pulmonary embolism in solid-organ transplant recipients. Exp Clin Transplant 2015;13(suppl 1):223-227.
- Verhave JC, Tagalakis V, Suissa S, Madore F, Hébert MJ, Cardinal H: The risk of thromboembolic events in kidney transplant patients. Kidney Int 2014;85:1454-1460.
- Poli D, Zanazzi M, Antonucci E, Bertoni E, Salvadori M, Abbate R, et al: Renal transplant recipients are at high risk for both symptomatic and asymptomatic deep vein thrombosis. J Thromb Haemost 2006;4:988-992.
- Abbott KC, Cruess DF, Agodoa LY, Sawyers ES, Tveit DP: Early renal insufficiency and late venous thromboembolism after renal transplantation in the United States. Am J Kidney Dis 2004;43:120-130.
- Humar A, Johnson EM, Gillingham KJ, Sutherland DE, Payne WD, Dunn DL, et al: Venous thromboembolic complications after kidney and kidney-pancreas transplantation: a multivariate analysis. Transplantation 1998;65:229-234.
- Bergqvist D, Bergentz SE, Bornmyr S, Husberg B, Konrad P, Ljungnér H: Deep vein thrombosis after renal transplantation: a prospective analysis of frequency and risk factors. Eur Surg Res 1985;17:69-74.
- Ahn S, Kim MH, Jun KW, Hwang JK, Park SC, Moon IS, et al: The incidence and risk factors for deep vein thrombosis after kidney transplantation in Korea: single-center experience. Clin Transplant 2015;29:1181-1186.
- Abualhassan N, Aljiffry M, Thalib L, Coussa R, Metrakos P, Hassanain M: Post-transplant venous thromboembolic events and their effect on graft survival. Saudi J Kidney Dis Transpl 2015;26:1-5.
Statistics Canada: Population and Dwelling Count Highlight Tables, 2016 Census. http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/pd-pl/Table.cfm?Lang=Eng&T=101&S=50&O=A (cited May 30, 2017).
- Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative: The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344-349.
- Lam NN, McArthur E, Kim SJ, Knoll GA: Validation of kidney transplantation using administrative data. Can J Kidney Health Dis 2015;2:20.
- Lam NN, Kim SJ, Knoll GA, McArthur E, Lentine KL, Naylor KL, et al: The risk of cardiovascular disease is not increasing over time despite aging and higher comorbidity burden of kidney transplant recipients. Transplantation 2017;101:588-596.
- Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, et al: Gestational hypertension and preeclampsia in living kidney donors. New Engl J Med 2015;372:124-133.
- Young A, Kim SJ, Garg AX, Huang A, Knoll G, Prasad GV, et al: Living kidney donor estimated glomerular filtration rate and recipient graft survival. Nephrol Dial Transplant 2014;29:188-195.
- Garg AX, Meirambayeva A, Huang A, Kim J, Prasad GV, Knoll G, et al: Cardiovascular disease in kidney donors: matched cohort study. BMJ 2012;344:e1203.
- Thomas SM, Lam NN, Huang A, Nash DM, Prasad GV, Knoll GA, et al: Risk of serious gastrointestinal bleeding in living kidney donors. Clin Transplant 2014;28:530-539.
- Thomas SM, Lam NN, Welk BK, Nguan C, Huang A, Nash DM, et al: Risk of kidney stones with surgical intervention in living kidney donors. Am J Transplant 2013;13:2935-2944.
- Lam N, Huang A, Feldman LS, Gill JS, Karpinski M, Kim J, et al; Donor Nephrectomy Outcomes Research (DONOR) Network: Acute dialysis risk in living kidney donors. Nephrol Dial Transplant 2012;27:3291-3295.
- Lam NN, Weir MA, Yao Z, Blake PG, Beyea MM, Gomes T, et al: Risk of acute kidney injury from oral acyclovir: a population-based study. Am J Kidney Dis 2013;61:723-729.
- Young A, Kim SJ, Speechley MR, Huang A, Knoll GA, Prasad GV, et al: Accepting kidneys from older living donors: impact on transplant recipient outcomes. Am J Transplant 2011;11:743-750.
- Siddiqui NF, Coca SG, Devereaux PJ, Jain AK, Li L, Luo J, et al: Secular trends in acute dialysis after elective major surgery-1995 to 2009. CMAJ 2012;184:1237-1245.
- Al-Ani F, Shariff S, Siqueira L, Seyam A, Lazo-Langner A: Identifying venous thromboembolism and major bleeding in emergency room discharges using administrative data. Thromb Res 2015;136:1195-1198.
Austin PC: Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 2009;38:1228-1234.
- Lentine KL, Schnitzler MA, Garg AX, Xiao H, Axelrod D, Tuttle-Newhall JE, et al: Understanding antihypertensive medication use after living kidney donation through linked national registry and pharmacy claims data. Am J Nephrol 2014;40:174-183.
- Lam NN, Lentine KL, Levey AS, Kasiske BL, Garg AX: Long-term medical risks to the living kidney donor. Nat Rev Nephrol 2015;11:411-419.
- Todeschini P, La Manna G, Dalmastri V, Feliciangeli G, Cuna V, Montanari M, et al: Incidence of late deep venous thrombosis among renal transplant patients. Transplant Proc 2013;45:2666-2668.
- Chang SH, Russ GR, Chadban SJ, Campbell SB, McDonald SP: Trends in kidney transplantation in Australia and New Zealand, 1993-2004. Transplantation 2007;84:611-618.
- Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al: United states renal data system 2011 annual data report: atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis 2012;59:A7.e1-e420.
- Knoll GA: Kidney transplantation in the older adult. Am J Kidney Dis 2013;61:790-797.
- Cavanaugh PK, Chen AF, Rasouli MR, Post ZD, Orozco FR, Ong AC: Total joint arthroplasty in transplant recipients: in-hospital adverse outcomes. J Arthroplasty 2015;30:840-845.
- Sood MM, Garg AX, Bota SE, Marisiddappa L, McArthur E, Naylor KL, et al: Risk of major hemorrhage after kidney transplantation. Am J Nephrol 2015;41:73-80.
- Quan H, Khan N, Hemmelgarn BR, Tu K, Chen G, Campbell N, et al: Validation of a case definition to define hypertension using administrative data. Hypertension 2009;54:1423-1428.
- Hux JE, Ivis F, Flintoft V, Bica A: Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 2002;25:512-516.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.