Renal transplantation in patients with hypercoagulable states

Early vascular thrombotic complications in renal transplantation frequently result in loss of the allograft with an increased long-term incidence of renal dysfunction from venous and arterial thrombosis. Hypercoagulable states are recognized risk factors of allograft thrombosis but are seldom discussed in the literature. This is the first report of preemptive heparin anticoagulation of two hypercoagulable patients undergoing renal transplantation, resulting in long term allograft success with warfarin anticoagulation. We recommend that any hemodialysis patient who has had recurrent dialysis graft thrombosis with a few months' time be evaluated for possible hypercoagulable state. Our experience suggests that appropriate management of such patients includes warfarin therapy. Renal transplantation can be successful in such patients provided heparin is given before, during, and after surgery followed by reinstitution of warfarin prior to discharge from the hospital.