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The use of thromboelastography to assess post-operative changes in coagulation and predict graft function in renal transplantation.

  • Author(s): Walker, Carson B
  • Moore, Hunter B
  • Nydam, Trevor L
  • Schulick, Alexander C
  • Yaffe, Hillary
  • Pomposelli, James J
  • Wachs, Michael
  • Bak, Thomas
  • Conzen, Kendra
  • Adams, Megan
  • Pshak, Thomas
  • Choudhury, Rashikh
  • Chapman, Michael P
  • Pomfret, Elizabeth A
  • Kennealey, Peter
  • et al.
Abstract

Background

End stage renal disease (ESRD) is associated with elevated fibrinogen levels and fibrinolysis inhibition. However, there is a paucity of data on how renal transplantation impacts coagulation. we hypothesize that renal transplantation recipients with good functioning grafts will have improved fibrinolytic activity following surgery.

Methods

Kidney recipients were analyzed pre-operatively and on post-operative day 1(POD1) using three different TEG assays with and without two concentration of tissue-plasminogen activator (t-PA). TEG indices and percent reduction in creatinine from pre-op to POD1 were measured, with >50% defining "good" graft function. Follow up was done at 6, 12, and 24 months.

Results

Percent lysis(LY30) on POD1 the t-PA TEG was significantly correlated to change creatinine from pre-op to POD-1(p = 0.006). A LY30 ≥ 23% was associated with good early graft function, and lower creatinine at 24-months(p = 0.028) compared to recipients with low POD1 LY30.

Conclusions

Post-operative tPA-TEG LY30 is associated with favorable early and late outcomes in kidney transplant.

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