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Thromboembolic complications and haemostatic changes in cyclosporin-treated cadaveric kidney allograft recipients
Insights
Cyclosporine treatment in kidney transplant recipients significantly increased the risk of thromboembolic complications compared to azathioprine. This immunosuppressive drug may alter hemostasis, leading to clot formation.
Area of Science:
- Nephrology
- Transplantation Immunology
- Hematology
Background:
- Thromboembolic complications are a significant concern in kidney transplant recipients.
- Immunosuppressive regimens play a crucial role in managing transplant outcomes.
- Cyclosporine and azathioprine are commonly used immunosuppressants with distinct mechanisms and side effect profiles.
Purpose of the Study:
- To compare the incidence of thromboembolic complications between kidney allograft recipients treated with cyclosporine and low-dose steroids versus those treated with azathioprine, antilymphocyte globulin, and high-dose steroids.
- To investigate potential hemostatic alterations associated with cyclosporine therapy.
Main Methods:
- Retrospective comparison of 90 cadaveric kidney allograft recipients in each treatment group.
- Detailed recording and analysis of thromboembolic events.
- Hemostatic function tests including coagulation factors and platelet aggregation in patient groups and normal subjects.
Main Results:
- The cyclosporine group experienced a significantly higher incidence of thromboembolic complications (17 events in 13 patients) including pulmonary emboli, renal vein thrombosis, deep vein thrombosis, and haemorrhoidal thrombosis.
- The azathioprine group had only one case of superficial thrombophlebitis.
- Cyclosporine-treated patients showed elevated levels of factor VIII C, fibrinogen, antithrombin III, and protein C, along with enhanced adenosine-5'-diphosphate-induced platelet aggregation compared to azathioprine-treated patients and controls.
Conclusions:
- Cyclosporine therapy is associated with a markedly increased risk of thromboembolic complications in kidney allograft recipients.
- Alterations in coagulation factors and platelet function induced by cyclosporine may contribute to this heightened thrombotic risk.
- These findings suggest a need for careful monitoring of hemostatic parameters in patients receiving cyclosporine post-transplantation.
Abstract:
The incidence of thromboembolic complications was compared retrospectively in 90 cadaveric kidney allograft recipients treated with cyclosporin and low-dose steroids and the same number of cadaveric kidney allograft recipients treated with azathioprine, antilymphocyte globulin, and high-dose steroids. In the cyclosporin group, 17 thromboembolic complications occurred in 13 patients: 10 pulmonary emboli, 1 renal vein thrombosis, 3 deep vein thromboses, and 3 haemorrhoidal thromboses. In the azathioprine group, the only thromboembolic complication was 1 episode of superficial thrombophlebitis. Haemostatic tests in cyclosporin-treated and azathioprine-treated patients and normal subjects (10 in each group) showed increased concentrations of factor VIII C, fibrinogen, antithrombin III, and protein C in the cyclosporin-treated patients. Adenosine-5'-diphosphate-induced platelet aggregation was also significantly enhanced in the cyclosporin group. The effect of cyclosporin on haemostasis may predispose to thromboembolic complications.