Ann Surg Treat Res.  2020 Jun;98(6):324-331. 10.4174/astr.2020.98.6.324.

Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients

• Kim MH
• Jun KW
• Hwang JK
• Park SC
• Yun SS
• Moon IS
• Kim JI

• KMID: 2502118
• DOI: http://doi.org/10.4174/astr.2020.98.6.324

Abstract

Purpose
Isolated distal deep vein thrombosis (IDDVT) is a localized lesion; nonetheless, the risk of proximal vein propagation makes it difficult to decide on the treatment protocol—that is, whether immediate anticoagulation after diagnosis or surveillance via serial imaging should be employed. This study aimed to investigate the appropriate treatment protocol for IDDVT in kidney transplant recipient (KTR).
Methods
Surveillance for venous thromboembolism (VTE) was performed using duplex ultrasonography (DUS) before transplant surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after transplant surgery. Dual mechanical prophylaxis was administered to prevent VTE.
Results
In total, 60 out of 829 patients (7.2%) developed VTE, with 49 cases (81.6%) of IDDVT. Among IDDVT patients, 15 patients were treated using anticoagulation-first strategy, whereas the remaining 34 patients were treated using surveillance-first strategy. No patient in either group exhibited thrombus extension into the proximal vein or recurrence within 1 year from transplant surgery.
Conclusion
In Korean KTR, extension of IDDVT into the proximal vein could be prevented safely and effectively by serial DUS surveillance along with the maintenance of mechanical prophylaxis. However, the patients who have high thrombus burden or are difficult to get repeated DUS require the use of anticoagulation in early stages.

Keyword

Anticoagulants; Kidney transplantation; Venous thrombosis

Figure

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  Fig. 1 Summary of patient selection. Total 829 kidney transplantation (KT) recipients were included and 49 patients were diagnosed isolated distal deep vein thrombosis (IDDVT). F/U, follow-up; VTE, venous thromboembolism; DVT, deep vein thrombosis.

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  Fig. 2 The different strategies for isolated distal deep vein thrombosis (IDDVT) management. There were differences in IDDVT management strategy according to the time period. During period 1, the patients diagnosed with IDDVT immediately started anticoagulation treatment. During period 2, the patients underwent surveillance examination every 1–2 weeks to decide whether or not the patient should receive anticoagulation treatment.

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  Fig. 3 Patient distribution according to a time of isolated distal deep vein thrombosis (IDDVT) diagnosis. Most of IDDVT diagnosed within 1 month after kidney transplantation. However, delayed type of IDDVTs were occurred till 6 months later.

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  Fig. 4 Schematic descript of patient allocation. Nineteen patients were diagnosed with isolated distal deep vein thrombosis (IDDVT) during period 1 and 30 patients were in period 2. (A and B) According to the specific indications (a and b), overall 15 patients were treated by anticoagulation-first strategy and 34 patients were managed by surveillance first strategy.

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