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INTRODUCTION:
In the pediatric renal transplant population, thrombophilic states can lead to vascular complications. Literature for pre-transplant thrombophilia incidence in this population is sparse with no data examining the thrombophilia incidence across ESRD etiologies. Our study aims to compare thrombophilia incidence between anatomic and autoimmune ESRD categories and to examine outcomes.
METHODS:
A retrospective analysis was done on patients referred for transplantation. Since 2005 thrombophilia screening was performed on all referred ESRD patients. An anatomic group (group A) was defined as ESRD caused by congenital dysplasia, reflux nephropathy, bladder exstrophy or obstructive uropathy. An autoimmune group/non-anatomic group (group NA) was defined as ESRD caused by glomerulonephritides or atypical hemolytic uremic syndrome. Patients were managed post-operatively with anticoagulation according to coagulation risk profile. The incidences, thrombophilia types, and graft outcomes were compared.
RESULTS:
24/62 patients had one or more thrombophilia risk factors. 12/21 in group NA and 10/36 in group A (p<0.05). No differences in outcomes were noticed between groups A and NA or those with and without thrombophilia. The most common thrombophilic defect in group NA was lupus anticoagulant/antiphospholipid syndrome. Homozygous MHTFR mutation was the most common in group A.
CONCLUSIONS: Compared to the general population, there is a higher incidence of undetected thrombophilia in our pediatric ESRD population. This risk is higher in patients with ESRD of NA etiology with a relatively higher prevalence of lupus anticoagulant/antiphospholipid syndrome.By identifying and using postoperative anticoagulation based on pre-transplant thrombophilia screening, there are equivalent transplant outcomes in these two populations.