Effect of Pre-Transplant Renal Anticoagulation and Antiplatelet Therapy on Post-Transplant Outcomes: A Retrospective Single-Center Study

Abstract

The management of anticoagulation and antiplatelet therapy in stage V chronic kidney disease (CKD) patients undergoing renal transplantation remains controversial. Some centers advocate for the use of reversal agents or procoagulants preoperatively, while others suggest that transplantation can proceed safely without halting these treatments. This study aims to evaluate the incidence of hemorrhagic and thrombotic complications in the first 72 hours post-transplant in patients receiving anticoagulant or antiplatelet therapy compared to a control group without such treatments. We conducted a retrospective cohort study involving 168 kidney transplant patients at our center from June 2018 to February 2022, with a follow-up period of 6 months post-transplant. Among these, 147 patients were included: 8.2% were anticoagulated, 16.3% were on antiplatelet therapy, and 75.5% received neither treatment. Patients on anticoagulants or antiplatelets were generally older, had a higher prevalence of cardiovascular history, and experienced longer dialysis times. Anticoagulated patients exhibited longer cold ischemia times and increased rates of hyperimmunization, alongside prolonged hospital stays. The overall incidence of hemorrhagic complications in the first 3 days post-transplant was low across all groups: 9% in the control group, 8.3% in anticoagulated patients, and 8.4% in antiplatelet-treated patients, with no significant differences. Blood transfusion rates were 75% for anticoagulated patients, 62.5% for antiplatelet patients, and 51.7% for controls (P = .214). Renal function at 6 months was similar across groups (P = .477), though acute rejection rates were higher in anticoagulated patients (16.6% vs. 4.2% vs. 2.7%; P = .067). No significant differences were found in hemorrhagic and thrombotic complications among the groups.