The role of anticoagulation in kidney transplantations from udcd with high resistance index

Abstract Background Kidney transplantations (KT) from uncontrolled donation after cardiac death (uDCD) achieve very good outcomes to short and long follow-up, but the incidence of primary non-function and venous thrombosis (VT) is very high. The resistance index (RI) after kidney transplantation increase in the VT cases and in other kidney diseases. Aims To describe the effect of prophylactic anticoagulation in KT from uDCD with RI ≥0.8 to avoid VT and its secondary effect. Method Unicentric retrospective cohorts study that included all KT from uDCD with RI ≥0.8 measured by ecodoppler in the first 72 hours post-transplantation. We compared one group, which never received anticoagulation (Group I), and a second one which received prophylactic anticoagulation (Group II). Sodic heparin was the administer anticoagulant to achieve aPTT 1.5-2 time normal range and/or low molecular weight heparin adjusted to patient's weight and renal function. Results We included 107 KT from uDCD with RI≥0.8, with 36 in Group I and 76 in Group II. In Group I the donors were younger (39 ± 12 vs 46 ± 8; p = 0.003) and there were more men donors (97.2% vs 81.7%; p = 0.032). The prevalence of VT was higher in Group I (19.4% vs 0%; p<0.001). Patients in Group II needed more red blood transfusions (19.4% vs 39.4%; p = 0.05) and had more macroscopic haematuria (5.6% vs 21.1%; p = 0.049). The competing risk analysis showed a higher probability to develop a VT in non-anticoagulation group (p = 0.00012) than anticoagulation group or other causes of primary non-function (Figure 1). Conclusion The prophylactic anticoagulation treatment in KT from uDCD with RI≥0.8 decreases the VT incidence and it is safe for a donor recipient.