Deep venous thrombosis after renal transplantation.
Four hundred and eighty consecutive renal transplant operations performed upon adults over a ten year period were reviewed to obtain the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE), or both. Using strict objective diagnostic criteria, 40 (8.3 per cent) thrombotic events were diagnosed, comprising 25 lower limb DVT alone, 11 DVT with PE and four PE alone. Four deaths were directly attributable to PE which was the fourth major cause of death in the review period. DVT was more common on the side of the transplant but the difference was not significant. The low incidence of thrombotic events (1.7 per cent) in the first month of transplantation does not suggest that chemical prophylaxis should be used during this period. However, the peak incidence occurred in the fourth month after transplantation which may be associated with a significant rise in mean hemoglobin concentration in both the thrombotic population and a control group of transplant recipients. Patient age at the time of transplantation and predisposing events, such as prolonged bedrest, further surgical treatment and pelvic pathology, were significant risk factors. All of the patients in the thrombotic population were receiving steroids at the time of diagnosis and no thrombotic events were demonstrated in patients receiving cyclosporin alone. The results of this review suggest that chemical prophylaxis is indicated for patients more than 40 years of age, with stable renal function and receiving steroids, who undergo periods of prolonged bedrest or further surgical treatment at some time after renal transplantation.