VENOUS THROMBOEMBOLIC COMPLICATIONS AFTER KIDNEY AND KIDNEY-PANCREAS TRANSPLANTATION - A MULTIVARIATE-ANALYSIS

Background, We reviewed the incidence of and risk factors for venous t hromboembolic complications in our population of kidney (KTx) and simu ltaneous kidney-pancreas transplant (SPK) recipients. Methods. Informa tion was collected retrospectively from a database on 1833 KTx and 276 SPK recipients who underwent transplant surgery between January 1985 and August 1995, Results. The incidence of deep venous thrombosis (DVT ) was 6.2%(n=132), with significantly higher rates after SPK (18.1%) v s, KTx (4.5%) (P<0.001), The number of DVT episodes was highest in the first month; 17.5% occurred during this time, For KTx recipients, ear ly thrombotic events were more common on the side of the graft (P=0.03 ); however, after 1 month, no correlation existed between the side of the graft and the side of DVT, For SPK recipients, DVT tended to be mo re common on the side of the pancreas (57%) vs, the kidney (43%) (P=0. 10). By multivariate analysis, risk factors for DVT were: age >40 year s (odds ratio [OR]=2.2, P<0.001), diabetes mellitus (DM) (OR=2.0, P=0. 002), previous DVT (OR=4.4, P=0.001), and SPK transplant (OR=2.8, P<0. 001). Pulmonary embolus (PE) was identified in 44 recipients (incidenc e, 2.1%) and was fatal in 13 (30%). The incidence was significantly hi gher in SPK (4.71%) vs, KTx recipients (1.69%) (P<0.01), The risk of d eath from PE was 0.5% in KTx recipients and 1.37% in SPK recipients (P =0.08), Risk factors for PE included DM (OR=2.6, P=0.005) and recent D VT (OR=8.9, P=0.0001), Conclusions. Based on risk and extrapolating fr om the general surgical literature, our recommendations for prophylaxi s against DVT are use of graduated compression stockings for all recip ients and, in addition, low-dose heparin for moderate and high-risk re cipients (previous DVT, SPK, age>40 years, DM).