Risk of Venous Thromboembolism in Kidney Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease
Thomas Bais, Ahmad A. Alnaim, Erzsi Tegzess, Isabelle Binet, Michael Dickenmann, Dela Golshayan, Fadi Haidar, Christian Kuhn, Thomas Schachtner, Kerstin Hübel, Karina Meijer, Michele F. Eisenga, Jan-Stephan Sanders, Stefan P. Berger, Ron T. Gansevoort, Daniel Sidler, Federica BocchiBackground:
Kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) may be at higher risk of venous thromboembolism than non-ADPKD recipients.
Methods:
We conducted an observational study of adult kidney transplant recipients at a single center, the University Medical Center Groningen (UMCG; n=1179, 393 with ADPKD), and replicated key analyses in the multicenter Swiss Transplant Cohort Study (STCS; n=4415, 710 with ADPKD). The primary endpoint was time to first venous thromboembolism after transplantation or death related to venous thromboembolism (identified through medical record review), analyzed using Kaplan–Meier estimates and Cox regression. Data were pooled for subgroup analyses and to assess determinants of post-transplant venous thromboembolism risk.
Results:
Venous thromboembolism occurred more often in ADPKD than non-ADPKD kidney transplant recipients (log-rank p=0.04 and p<0.001 for UMCG and STCS, respectively). The 10-year cumulative venous thromboembolism incidence was 13.5% [95% CI: 9.4, 17.5], versus 9.6% [95% CI: 7.0, 12.1] in ADPKD versus non-ADPKD recipients in UMCG, and 21.0% [95% CI: 17.0, 24.7] versus 15.1% [95% CI: 13.5, 16.6] in STCS. Median [Q1, Q3] time to venous thromboembolism were similar across cohorts (UMCG: 1.7 [0.4, 4.9], STCS: 1.4 [0.2, 4.8] years). Venous thromboembolism risk was highest in the early (<2 years) post-transplant period. After adjustment for venous thromboembolism risk factors, ADPKD remained independently associated with post-transplant venous thromboembolism in both cohorts (UMCG HR 1.80 [95% CI: 1.21, 2.69]; STCS HR 1.39 [95% CI: 1.13, 1.72]). The association between ADPKD and risk of venous thromboembolism was more pronounced in males. Hemoglobin levels after kidney transplantation were approximately 7.0 ± 0.8% higher in ADPKD recipients, particularly in males, with corresponding higher risks of erythrocytosis during follow-up. Incorporating longitudinal hemoglobin as a time-varying covariate attenuated the association between ADPKD and venous thromboembolism, suggesting that the association was at least partially driven by higher hemoglobin levels.
Conclusions:
Kidney transplant recipients were at high risk for venous thromboembolism, and those with ADPKD are at an even higher risk.