Objective: Due to the high prevalence and incidence of cardio- and cerebrovascular diseases
among dialysis-dependent patients with end-stage renal disease (ERSD) scheduled for kidney
transplantation (KT), the use of antiplatelet therapy (APT) and/or anticoagulant drugs in this patient
population is common. However, these patients share a high risk of complications, either due to
thromboembolic or bleeding events, which makes adequate peri- and post-transplant anticoagulation
management challenging. Predictive clinical models, such as the HAS-BLED score developed for
predicting major bleeding events in patients under anticoagulation therapy, could be helpful tools for
the optimization of antithrombotic management and could reduce peri- and postoperative morbidity
and mortality. Methods: Data from 204 patients undergoing kidney transplantation (KT) between
2011 and 2018 at the University Hospital Leipzig were retrospectively analyzed. Patients were
stratified and categorized postoperatively into the prophylaxis group (group A)—patients without
pretransplant anticoagulation/antiplatelet therapy and receiving postoperative heparin in prophylactic
doses—and into the (sub)therapeutic group (group B)—patients with postoperative continued
use of pretransplant antithrombotic medication used (sub)therapeutically. The primary outcome
was the incidence of postoperative bleeding events, which was evaluated for a possible association
with the use of antithrombotic therapy. Secondary analyses were conducted for the associations of
other potential risk factors, specifically the HAS-BLED score, with allograft outcome. Univariate and
multivariate logistic regression as well as a Cox proportional hazard model were used to identify risk
factors for long-term allograft function, outcome and survival. The calibration and prognostic accuracy
of the risk models were evaluated using the Hosmer–Lemshow test (HLT) and the area under
the receiver operating characteristic curve (AUC) model. Results: In total, 94 of 204 (47%) patients received
(sub)therapeutic antithrombotic therapy after transplantation and 108 (53%) patients received
prophylactic antithrombotic therapy. A total of 61 (29%) patients showed signs of postoperative
bleeding. The incidence (p < 0.01) and timepoint of bleeding (p < 0.01) varied significantly between
the different antithrombotic treatment groups. After applying multivariate analyses, pre-existing
cardiovascular disease (CVD) (OR 2.89 (95% CI: 1.02–8.21); p = 0.04), procedure-specific complications
(blood loss (OR 1.03 (95% CI: 1.0–1.05); p = 0.014), Clavien–Dindo classification > grade II (OR 1.03
(95% CI: 1.0–1.05); p = 0.018)), HAS-BLED score (OR 1.49 (95% CI: 1.08–2.07); p = 0.018), vit K antagonists
(VKA) (OR 5.89 (95% CI: 1.10–31.28); p = 0.037), the combination of APT and therapeutic
heparin (OR 5.44 (95% CI: 1.33–22.31); p = 0.018) as well as postoperative therapeutic heparin (OR 3.37
(95% CI: 1.37–8.26); p < 0.01) were independently associated with an increased risk for bleeding. The
intraoperative use of heparin, prior antiplatelet therapy and APT in combination with prophylactic heparin was not associated with increased bleeding risk. Higher recipient body mass index (BMI)
(OR 0.32 per 10 kg/m2 increase in BMI (95% CI: 0.12–0.91); p = 0.023) as well as living donor KT
(OR 0.43 (95% CI: 0.18–0.94); p = 0.036) were associated with a decreased risk for bleeding. Regarding
bleeding events and graft failure, the HAS-BLED risk model demonstrated good calibration (bleeding
and graft failure: HLT: chi-square: 4.572, p = 0.802, versus chi-square: 6.52, p = 0.18, respectively) and
moderate predictive performance (bleeding AUC: 0.72 (0.63–0.79); graft failure: AUC: 0.7 (0.6–0.78)).
Conclusions: In our current study, we could demonstrate the HAS-BLED risk score as a helpful tool
with acceptable predictive accuracy regarding bleeding events and graft failure following KT. The
intensified monitoring and precise stratification/assessment of bleeding risk factors may be helpful
in identifying patients at higher risks of bleeding, improved individualized anticoagulation decisions
and choices of antithrombotic therapy in order to optimize outcome after kidney transplantation
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:87859 |
| Date | 02 November 2023 |
| Creators | Hau, Hans Michael, Eckert, Markus, Laudi, Sven, Völker, Maria Theresa, Stehr, Sebastian, Rademacher, Sebastian, Seehofer, Daniel, Sucher, Robert, Piegeler, Tobias, Jahn, Nora |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 4025 |
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