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Updated: Jun 17, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Preventing graft thrombosis after renal transplantation: a multicenter survey of clinical practice
T Ripert1, J Menard, Y Schoepen
1Department of Urology, CHU Robert Debre, REIMS, Champagne Ardennes, France. thomas_ripert@yahoo.fr
Background:
Renal allograft vascular thrombosis is a complication that often results in graft loss. Since there are no guidelines on immediate postoperative thromboprophylaxis, we performed a telephone survey of clinical practice in all renal transplantation centers in France.
Methods:
Each center considered 4 cases relating to renal transplant candidates on dialysis with an increasing risk of thrombosis: Case 1: patient with no identified risk factors; Case 2: patient with an earlier incidence of deep vein thrombosis; Case 3: patient with ischemic heart disease on antiplatelet therapy; Case 4: patient with atrial fibrillation taking a vitamin K antagonist (VKA) with lupus nephritis syndrome.
Results:
The treatments proposed by the centers (%) were: Case 1: No anticoagulation therapy (57.1%), calcium heparin at prophylactic doses (P-dose) (40%), or unfractionated heparin (UFH); (P-dose; 2.9%). Case 2: No anticoagulation therapy (34.3%), calcium heparin (P-dose; 51.4%), or UFH (P-dose; 5.7%). Case 3: (A) Interruption of aspirin (65.7%), and either no anticoagulation therapy (21.7%) or substitution of aspirin by calcium heparin (P-dose; 56.6%) or by UFH (P-dose; 8.7%). (B) No interruption of aspirin (34.3%), and either no additional prophylaxis (58.3%) or calcium heparin (P-dose; 33.3%). Case 4: Interruption of VKA (100%), and UFH at a curative dose (68.6%), UFH (P-dose; 14.3%), or calcium heparin (P-dose; 11.4%).
Conclusions:
Practices varied widely in the absence of studies of sufficiently high power. There is a need for a preoperative classification of thrombotic and hemorrhagic risk among renal transplant candidates and for consensus guidelines.
Insights
Renal transplant thromboprophylaxis practices vary widely among French centers. This survey highlights the need for clear guidelines to manage thrombosis risk in kidney transplant candidates.
Area of Science:
- Nephrology
- Transplantation Surgery
- Vascular Surgery
Background:
- Renal allograft vascular thrombosis is a significant cause of graft loss.
- Current guidelines for immediate postoperative thromboprophylaxis are lacking.
- Clinical practice in French renal transplantation centers was surveyed.
Purpose of the Study:
- To assess current clinical practices regarding thromboprophylaxis in renal transplant candidates.
- To identify variations in treatment strategies based on patient risk factors.
Main Methods:
- A telephone survey was conducted across all French renal transplantation centers.
- Four distinct patient cases with increasing thrombosis risk were presented.
- Centers' proposed treatments for each case were recorded.
Main Results:
- Significant variability in anticoagulation strategies was observed across centers and patient risk levels.
- For low-risk patients, no anticoagulation was the most frequent approach (57.1%).
- For high-risk patients (e.g., atrial fibrillation with VKA), interruption of VKA and use of unfractionated heparin (UFH) at curative dose was common (68.6%).
Conclusions:
- Wide variations in practice underscore the absence of high-powered studies.
- A need exists for preoperative risk stratification (thrombotic and hemorrhagic) for renal transplant candidates.
- Development of consensus guidelines for thromboprophylaxis is recommended.
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