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[Prevention of vascular thromboses after renal transplantation using low molecular weight heparin]
M Broyer1, M F Gagnadoux, A Sierro
1Service de Néphrologie Pédiatrique, Hôpital Necker, Paris.
Insights
Low molecular weight heparin (Enoxaparin) effectively prevents renal graft thrombosis in pediatric kidney transplant recipients. This treatment significantly reduces transplant failure due to thrombosis, even in high-risk young patients.
Area of Science:
- Nephrology
- Pediatric Surgery
- Pharmacology
Background:
- Vascular thrombosis is a primary cause of early graft loss in pediatric kidney transplant recipients.
- Certain risk factors, including young donor/recipient age and multiple transplant arteries, increase thrombosis risk.
Purpose of the Study:
- To evaluate the efficacy of low molecular weight heparin (Enoxaparin) in preventing renal graft thrombosis in pediatric kidney transplant patients.
- To assess the impact of Enoxaparin prophylaxis on transplant survival rates in high-risk pediatric recipients.
Main Methods:
- An open trial was conducted involving pediatric kidney transplant recipients.
- Prophylactic Enoxaparin was administered to a cohort of patients during 1989.
- Outcomes were compared to a historical control group from 1988 that did not receive Enoxaparin.
Main Results:
- The incidence of renal graft thrombosis was significantly lower in the Enoxaparin-treated group (1.5%) compared to the untreated group (12%).
- Enoxaparin therapy was associated with a higher rate of non-severe bleeding events (12/42 patients).
- Risk factors for thrombosis were comparable between the treated and untreated groups.
Conclusions:
- Enoxaparin is an effective prophylactic agent against renal graft thrombosis in pediatric kidney transplantation.
- This therapy enables the use of grafts from younger donors, previously deemed unsuitable.
- Enoxaparin prophylaxis improves transplant outcomes in pediatric patients, particularly those with identified risk factors.
Abstract:
Vascular thrombosis is one of the main causes of early transplant failure in pediatric patients. This paper reports the results of an open trial of the low molecular weight heparin (Enoxaparine) used to prevent renal graft thrombosis in pediatric recipients with risk factors including donor or recipient age under 5 years, multiple arteries supplying the transplant, and positive history for recurrent thrombosis. During 1989, 42 of 67 children given a renal transplant were prophylactically treated with Enoxaparin. Only one transplant was lost to thrombosis among treated patients (1.5%), versus 9 transplants among 73 (12%) children who received their kidney in 1988 without prophylactic Enoxaparin. Risk factors were comparable in both groups of recipients. Enoxaparine therapy was associated with an increased rate of bleeding (12/42) without severe consequences. In conclusion, Enoxaparin is effective in preventing renal graft thrombosis. Availability of this prophylactic therapy makes it possible to use transplants removed from the youngest donors considered as inadequate by some groups.