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Perioperative changes in coagulation in patients undergoing kidney transplantation using thromboelastography

ve To evaluate perioperative changes in coagulation in patients undergoing kidney transplantation using thromboelastography (TEG) and determine the effect of preoperative hemodialysis on coagulation. Methods Thirty-eight patients with end-stage renal disease undergoing kidney transplantation were divided into three groups according to the interval between the last hemodialysis and operation: in group A (n=16) the interval was 6h; in group B (n=12) the interval ranged from 6 to 24 h ; in group C (n=10)24 h. The operation was performed under continuous epidural block. Right subclavian or internal jugular vein was cannulated for blood sampling. Exclusion criteria included acute bleeding, acute thrombosis, patients who had received any drug which may affect platelet function or coagulation within a month. TEG was performed before operation, 10min after release of cross-clamping of artery and vein of the translated kidney and at the end of operation. The measured TED variables included the reaction time (r) representing the rate of initial fibrin formation; k(coagulation) time and alpha angle reflecting fibrin-platelet interaction and maximal amplitude (MA) indicating qualitative platelet function. Results Before operation in group A r and k values were both significantly smaller than normal values and alpha angle, MA and coagulation index (CI) significantly increased, indicating increased coagulability, while group C exhibited decreased coagulability with r-value larger than normal and MA smaller than normal. 10min after release of cross-clamping of artery and vein of the transplanted kidney in group B and C r-value decreased and MA, CI increased as compared with the preoperative values. There were no significant differences in TEG variables at the end of operation among the three groups. Conclusions TEG shows that hypercoagulability may exist within 6 h after hemodialysis, and there is likelihood of fibrinolysis after 24 h. The venous blood is hypercoagulable after the release of cross-clamping of artery and vein of the transplanted kidney, indicating the risk of potential thrombosis.