Venous Thromboembolism In Solid-Organ Transplant Recipients: Findings From The Riete Registry

Introduction: Venous thromboembolism (VTE) represents a relevant cause of morbidity in patients with solid-organ transplantation (SOT), which is recognized as an environmental risk factor for VTE. Nevertheless, there are few data about the management and outcomes in this special population. Methods: The RIETE registry is a worldwide, prospective cohort of consecutive patients presenting with objectively confirmed, acute VTE. We used the data from RIETE registry to describe the clinical and therapeutic characteristics in this population and to assess the outcomes of VTE during SOT. Results: Of 83,210 patients with VTE, SOT was reported in 329 (0.4%) patients. Of these, there were 221 kidney transplant recipients (TR), 41 liver TR, 28 lung TR and 25 heart TR. Patients with SOT were younger, more likely men and to have cardiovascular risk factors or recent surgery, and less likely to have active cancer. VTE in SOT recipients were initially presented with PE less frequently (34% vs 53%). Both anemia and plaquetopenia, and kidney insufficiency (60% vs 35%) were more likely in patients with SOT. Concerning long-term therapy, treatment duration was shorter in the SOT patients (255 vs 289 days), more often with LMWH [OR 1.64 (1.31-2.05)], and less often with DOAC [OR 0.36 (0.19-0-68)]. During the course of anticoagulation, the incidence of bleeding in the SOT recipients was higher, both major [HR 2.55 (1.62-3.84)] and non-major [HR 1.94 (1.23-2.93)]. There were no differences in the rate of recurrent VTE or overall mortality, but bleeding was the explanation of death more frequently in TR [HR 3.28 (1.20-7.33)]. Conclusions: VTE is associated with increased risk of bleeding in SOT recipients.