Use of anticoagulation in cadaver renal transplants

The effect of anticoagulation was studied in 92 consecutive cadaver renal transplants performed in 90 patients from 1977 to 1980. Patients were randomized to receive prophylactic anticoagulation with warfarin and antiplatelet drugs beginning on the second post-transplant day, or therapeutic heparin for acute rejection episodes with vascular involvement, only. These patients were later converted to long-term anticoagulation with warfarin and antiplatelet drugs. All first rejection episodes were diagnosed by percutaneous renal biopsy and scored as to the degree of cellular infiltrate and vascular change. Immunosuppression consisted of azathioprine, prednisone, methylprednisolone, and, in 19 patients, antilymphoblast globulin (ALG) given for 14 days post-transplant. Rejection episodes were treated in 76 patients. Severe rejection did not respond to any form of treatment and all these grafts failed in less than 3 months. Severe cellular rejection did not occur in ALG-treated patients. Heparin treatment improved the 3-month graft survival in patients with acute rejection and mild vascular changes but did not alter the results in any other category. Chronic rejection was not prevented by any method of anticoagulation. Bleeding complications occurred in 18.4% of patients receiving warfarin and 7.7% of the patients receiving heparin. Anticoagulation with heparin may be useful in the treatment of acute rejection with mild vascular changes. Biopsy-proven severe rejection accurately predicts early graft failure regardless of treatment and should prompt transplant nephrectomy.