Introduction: Patients with End stage renal disease with coronary artery disease (CAD) are on antiplatelet drugs and sometimes these drugs cannot be stopped at the time of transplant. This may increase peri-operative blood loss. However recent studies have reported conflicting data in terms of blood loss and subsequent operative intervention. We compared the peri-operative complications of kidney transplantation performed for patients on antiplatelet drugs versus those in whom these were discontinued pre-operatively.
Methods: We retrospectively analyzed the data of the kidney transplant patients with coronary artery disease, taking dual antiplatelet drugs (Clopidogrel 75 mg and Acetylsalicylic acid 150 mg). After pre-operative evaluation by a cardiologist, patients were segregated into two groups: Group A (drugs discontinued 5 days prior to procedure), Group B (drugs continued, because of the high risk of acute coronary event, on discontinuation). Both the groups were analyzed with respect to age, body mass index (BMI), history of maintenance hemodialysis (MHD), pre and postoperative hemoglobin (Postoperative day 2), intra-operative blood loss, drain output (DO), need for blood transfusion (BT), bleeding complications (need for any intervention), any cardiovascular event up to one month follow-up. Continuous variables were compared using Mann Whitney U test and Dichotomous variables were analyzed using Chi Square test, p value of 0.05 was considered significant.
Results: From December 2014 to January 2021, 106 patients were identified. Group A included 73 patients and group B included 33 patients. These groups were comparable in terms of age (p = 0.78), gender (p =0.62), BMI (p = 0.06), history of MHD (p = 1.87), pre and postoperative hemoglobin levels (p = 0.73 and 0.06, respectively), BL, and need for BT, Table 1. Group B had significantly higher DO. No adverse cardiovascular event was noted. No patient needed any intervention for bleeding.
Table 1. Peri-operative parameters
A
B
p
Blood loss (ml)@
290 (260-330)
280 (270-310)
0.21**
DO (ml)@
220 (196.32-244.35)
330 (301.60-358.26)
0.04**
BT
24/73
8/33
0.29*
@ Median + Interquartile range
* Chi Square
** Mann Whitney U
Conclusions: With proper attention to intra-operative hemostasis, renal transplants can be performed safely in patients of ESRD with CAD without stopping the dual antiplatelet drugs.
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