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

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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1511-1517
Number of pages7
JournalAmerican Journal of Surgery
Volume220
Issue number6
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Coagulation
  • Fibrinolysis
  • Kidney transplant
  • TEG
  • Thromboelastography
  • t-PA

ASJC Scopus subject areas

  • Surgery

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