Characteristics and posttransplant outcomes of patients with congenital and acquired von Willebrand disease and hemophilia A and with renal transplants

TL;DR

This study examines the risks and outcomes of kidney transplants in patients with bleeding disorders like hemophilia and von Willebrand disease.

Contribution

It provides insights into post-transplant bleeding, thrombosis, and rejection risks specific to patients with bleeding disorders.

Findings

Nearly half of patients experienced major bleeding within 30 days post-transplant.

Thrombotic events occurred in 36.4% of patients after one year.

Rejection rates were comparable to the general transplant population.

Abstract

Bleeding disorders such as hemophilia and von Willebrand disease (VWD) have historically been associated with significant morbidity due to hemarthrosis, surgical bleeding, and transfusion requirements. With advances in hemostatic therapy, surgical outcomes have improved; however, data on renal transplantation in this population remain limited.

To assess clinical characteristics and adverse events in renal transplant patients with bleeding diathesis, focusing on primary endpoints: post-transplant bleeding, thrombotic events, and mortality. Secondary endpoints include readmissions, OR takebacks, and renal transplant rejections, including acute cellular rejection and antibody-mediated rejection.

A retrospective chart review of renal transplant patients with bleeding diathesis across Mayo Clinic.

The cohort included 11 patients: hemophilia A (3/11) and VWD (8/11), with a mean Kidney Donor Profile Index of 37. Among patients with hemophilia A, 2 had congenital disease, and 1 had previously developed a factor VIII inhibitor that had resolved prior to transplantation. Among VWD patients, 6 had acquired VWD and 2 had type 1 VWD. No patients experienced arterial or venous thrombosis within 1 year. Beyond 1 year, 5 thrombotic events occurred in 4 patients (36.4%): 2 myocardial infarctions, 1 ischemic stroke, and 2 deep vein thromboses; no pulmonary emboli occurred. In the immediate postoperative period (days 0-30), 5 patients (45.5%) had bleeding events—4 major (80%) and 1 minor (20%). No bleeding occurred between days 30 and 365. After 1 year, 4 patients (36.4%) had nonallograft-related bleeding, primarily gastrointestinal. Readmission rates were 36.4% (0-30 days), 27.3% (30-90 days), and 9.1% (90-365 days). Surgical reintervention was required in 18.2% of patients. Rejection occurred in 3 patients (27.3%): 2 with acute cellular rejection, 1 with chronic cellular rejection, and 1 with antibody-mediated rejection. Overall mortality was 45%.

Kidney transplant recipients with hemophilia and VWD are at significant perioperative bleeding risk, particularly from perinephric hematomas and intraoperative hemorrhage. The risk decreases after 30 days, but long-term monitoring for both bleeding and thrombosis remains crucial. Rejection rates appear comparable with those of the general transplant population.

•Bleeding disorders make surgery and kidney transplant care more complex and higher risk.•This study evaluated kidney transplant outcomes in patients with hemophilia or von Willebrand disease.•Nearly half of patients had major bleeding in the first 30 days after transplant surgery.•After 30 days, bleeding declined, but late risks for blood clots and rejection remained significant.

Bleeding disorders make surgery and kidney transplant care more complex and higher risk.

This study evaluated kidney transplant outcomes in patients with hemophilia or von Willebrand disease.

Nearly half of patients had major bleeding in the first 30 days after transplant surgery.

After 30 days, bleeding declined, but late risks for blood clots and rejection remained significant.