COAGULATION AND FIBRINOLYSIS DURING THE FIRST YEAR OF IMMUNOSUPPRESSIVE TREATMENT IN RENAL-TRANSPLANTATION - CORRESPONDENCE BETWEEN HYPERCOAGULABLE STATE AND STEROID-THERAPY

An increased incidence of thromboembolic complications has been report ed after kidney transplantation, and hypercoagulability has been assoc iated with immunosuppressive treatment, specifically with Cyclosporin A. Hypercorticism due to prolonged steroid therapy or to Gushing's dis ease has been associated with a similar hypercoagulable state and thro mbotic risk. The aims of this study were first to evaluate coagulation and fibrinolytic behavior in 27 patients at different times during th e first year after renal transplantation and then to compare the same patients' coagulation and fibrinolytic findings 1 month after transpla ntation with those of a normal control group and a group of Gushing's patients. Compared with normal controls, renal transplant patients and Gushing's patients showed a similar hypercoagulable and hypofibrinoly tic state, with a significant shortening in activated partial thrombop lastin time and increase in factor VIII-von Willebrand factor complex, tissue plasminogen activator concentration, and plasminogen activator inhibitor activity and concentration. Other test results in the two g roups showed no differences. The same abnormalities were present in th e renal transplant group for the entire period of study. Our results s uggest that a hypercoagulable and hypofibrinolytic state persists almo st 1 year after renal transplantation and that these abnormalities are very similar to those present in Gushing's disease. Steroid treatment seems to play a key role in determining thromboembolic risk after ren al transplantation.