Impact of Pre-Transplant Anticoagulant and Antiplatelet Use on Allograft Outcomes Following Kidney Transplant

Patients presenting for kidney transplantation on antithrombotic therapy may face an increased risk of bleeding and surgery-related morbidity. How to best optimize pre-operative antithrombotic therapies to decrease the risk for allograft complications has not been fully elucidated.

This was a single-center, retrospective study of adult patients undergoing kidney transplantation between 2018-2024. Patients taking oral anticoagulants or antiplatelet therapies at the time of organ offer were compared to control patients not on antithrombotics. A subgroup analysis was also performed, comparing patients on warfarin versus apixaban. The primary endpoint was combined patient and allograft survival at 6 months post-transplant. Key secondary endpoints included the incidence of delayed allograft function, blood product requirements and re-operation, and estimated glomerular filtration rate.

27 patients on anticoagulants and 26 patients on antiplatelet therapies were compared to 227 controls. No significant differences were observed in allograft survival between anticoagulant (96.3%), antiplatelet (88.5%), and control (93.4%) groups. Patients on anticoagulants exhibited a higher incidence of bleeding complications including increased blood product requirements (2.0 vs. 0.6; p < 0.01) and re-operation (14.8% vs. 4.4%; p = 0.04) relative to controls, although this did not impact allograft function. No differences were observed in survival or bleeding endpoints between patients on warfarin and apixaban.

Use of anticoagulant but not antiplatelet therapy prior to transplantation was associated with an increased risk of bleeding complications, without adversely affecting short-term allograft function. These results suggest that anticoagulant and antiplatelet therapies may be continued until the time of organ offer in select patients, and apixaban may be a suitable alternative to warfarin for patients on the transplant waiting list.