Kidney retransplants after initial graft loss to vascular thrombosis

Background: Vascular thrombosis early after a kidney transplant is an infre quent but devastating complication. Often, no cause is found. These recipie nts are generally felt to be good candidates for a retransplant. However, t heir ideal care at the time of the retransplant and their outcomes have not been well documented. We studied outcomes in 16 retransplant recipients wh o had lost their first graft early posttransplant (< 1 month) to vascular t hrombosis. Methods: Of 2003 kidney transplants between 1 January 1984 and 30 September 1998, we identified 32 recipients who had lost their first graft early pos ttransplant to vascular thrombosis. Of these 32 recipients, 16 were subsequ ently retransplanted and detailed chart reviews were done. Results: Of the 16 retransplant recipients, 12 lost their first graft to re nal vein thrombosis and 4 to renal artery thrombosis. Thrombosis generally occurred early (mean, 3.6 d). Five recipients underwent a complete hematolo gic workup to rule out a thrombophilic disorder before their retransplant: 4 had a positive result (presence of antiphospholipid antibodies, n = 3; in creased homocysteine levels, n = 1). These 4 recipients, along with 1 other recipient who had a strong family history of thrombosis, underwent thrombo sis prophylaxis at the time of their retransplant. Prophylaxis consisted of low-dose heparin for the first 3-5 d posttransplant, followed by acetylsal icylic acid or Coumadin. Of the 16 retransplant recipients, none developed thrombosis. Of the 5 who underwent thrombosis prophylaxis, none had significant bleeding complicatio ns. At a mean follow-up of 5.4 yr, 10 (63%) recipients have functioning gra fts. Causes of graft loss in the remaining 6 recipients were death with fun ction (n = 5, 31%) and acute rejection (n = 1, 6%). Graft and patient survi val rates after these 16 retransplants were equivalent to results after pri mary transplants. The incidence of acute and chronic rejection was also no different (p = ns). Conclusion: Vascular thrombosis in the absence of obvious technical factors should prompt a workup for a thrombophilic disorder before a retransplant. Recipients with an identified disorder should undergo prophylaxis at the t ime of the retransplant. Results in these retransplant recipients are equiv alent to those seen in primary transplant recipients.