UTILITY OF PRE-KIDNEY TRANSPLANT THROMBOPHILIA SCREENING ON PREDICTING POST-TRANSPLANT VENOUS THROMBOEMBOLISM
Alastair Weng1,2, Kritika Chaiwatanatorn2, David Goodman1, Sharon Ford1 1Department of Nephrology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia2Department of Haematology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
Abstract
Aim: To examine whether routine thrombophilia screening is predictive of post-transplant venous thromboembolism (VTE) compared to other risk factors.
Background: VTE causes significant morbidity and mortality in kidney transplant populations, with a prevalence of 4.6-9.1%. The rate of inherited thrombophilias and thromboembolic risk factors (RF) are unknown.
Methods: Consecutive kidney transplant recipients (2014-2022) with at least twelve months follow-up at our transplant centre were included. Demographic data, thrombophilia results, thromboembolic RFs, and previous VTEs were recorded. The primary outcome was post-transplant thromboembolic events, including deep vein thrombosis (DVT), pulmonary embolus (PE), and renal vein thrombus (RVT). Secondary outcome measures included one-year post-transplant creatinine, rejection episodes, and time to first VTE.
Results: 153 patients received a transplant; median age was 56 (IQR 45-62); median follow-up was 6 years (range 1-9). 49/153 (32%) were female, 52/153 (34%) had body mass index (BMI) ≥30, and 69/153 (45%) were ex-smokers. Nine (5.9%) had inherited thrombophilias; four heterozygous Factor V Leiden, four heterozygous prothrombin gene mutation, and one anti-thrombin III deficiency. 7/153 patients had previous VTEs. There were 32 VTEs in 26 patients (17%) during the follow-up period, with 15 (10%) VTEs within 90 days of transplant. Patients with post-transplant VTE were older (57.9 vs 52.2 years, p<0.05), but no differences were seen in sex, BMI, history of VTEs, nor length of hospital stay. Positive thrombophilia screening was not associated with post-transplant VTE. Only three patients with positive thrombophilia screening had post-transplant VTEs, one within 90 days of transplant.
Conclusions: Routine thrombophilia screening did not predict post-transplant VTE, however traditional RFs were also poorly associated. This suggests thrombophilia screening may be omitted from transplant assessment, resulting in healthcare cost savings.
Biography
Dr Alastair Weng is a first-year Basic Physician Trainee based in Melbourne, graduating from University of Melbourne’s Rural Clinical School with first class honours. As an early-career clinician, he has wide-ranging interests including transplantation outcomes, kidney supportive care, and service delivery.
Shaun Summers Clinical Trainee Award Presentation PDF Slides