Managing Postoperative Hemorrhage after Kidney Transplant Surgery

Previous studies have reported rates of 14% of postoperative hemorrhage in kidney transplantation. There are few data available regarding the optimal strategy to manage postoperative hemorrhage in this patient population. R. Shaw and colleagues conducted a retrospective cohort study to test the hypothesis that there would be a difference in outcomes with operative versus non-operative management of hemorrhage following kidney transplantation. Results of the study were reported during a virtual poster session at the American Transplant Congress 2020 in a poster titled Operative vs Non-Operative Management of Hemorrhage in the Postoperative Kidney Transplant.

The study cohort included consecutive kidney transplants from 2012 to 2019 (living and deceased donors). Patients were classified as experiencing hemorrhage based on the objective finding of hematoma on either ultrasound or computed tomography (CT). Hemorrhage management was defined as operative (surgical intervention with or without transfusion) or non-operative (with or without transfusion).

Of the 1758 kidney transplants performed at the center, 8% (n=135) demonstrated hematoma on ultrasound or CT scan; of those, 66 had operative management and 69 had non-operative management. In the overall cohort, the clinical signs and symptoms of postoperative hemorrhage that were 92.5% predictive of postoperative hemorrhage were low urine output (P=.044), drop in hemoglobin (P<.000), abdominal pain (P=.005), and mean arterial pressure <70 mm Hg (P=.034).

The two groups (operative vs non-operative management) were similar in medical history, pre-operative anticoagulation, anastomosis type, cold ischemia time, lowest hemoglobin, delayed graft function, and complications. Patients in the group with non-operative management of postoperative hemorrhage had shorter length of stay (P<.000), better graft survival (P=.01), and better patient survival (P=.01) compared with those in the operative management group.

In summary, the researchers said, “We found better outcomes of graft and patient survival with shorter lengths of stay when we utilized non-operative management of postoperative hemorrhage in kidney transplant patients. Our findings suggest a role for conservative non-operative management in select patients. Ultimately, it is the surgeon’s choice of how best to manage the care of kidney transplant patients with postoperative hemorrhage.”

Source: Shaw R, Reavis T, Meruva V, et al. Operative vs non-operative management of hemorrhage in the postoperative kidney transplant patient. Abstract of a poster presented at the virtual American Transplant Congress 2020 (Abstract C-109), May 30, 2020.