Supplementary Material for: Antithrombotic Management in Adult Kidney Transplantation – A European survey study

In kidney transplantation (KTx), renal graft thrombosis (RGT) is one of the main reasons for early graft loss. Although evidence-based guidance on prevention of RGT is lacking, thromboprophylaxis is widely used. The aim of this survey was to obtain a European view of the different thromboprophylactic strategies applied in KTx.
An online 22-question survey, addressed to KTx professionals, was distributed by e-mail and via platforms of the European Society for Organ Transplantation.
Seventy-five responses (21 countries, 51 centers) were received: 75% had over 10 years’ clinical experience, 64% were surgeons, 29% nephrologists and 4% urologists. A written antithrombotic management protocol was available in 75% of centers. In 8 (16%) of centers respondents contradicted each other regarding the availability of a written protocol. Thromboprophylaxis is preferred by 78% of respondents, independent of existing antithrombotic management protocols. Ninety-two percent of respondents indicated that an anticipated bleeding risk is the main reason to discontinue chronic antithrombotic therapy preoperatively. Intraoperatively, 32% of respondents administer unfractionated heparin (400 – 10.000 international units with a median of 5000) in selected cases.
Despite an overall preference for perioperative thromboprophylaxis in KTx, there is a high variation within Europe regarding type, timing and dosage, most likely due to the paucity of high-quality studies. Further research is warranted in order to develop better guidelines.

在肾脏移植（KTx）领域，肾移植血管栓塞（RGT）是导致移植器官早期丧失的主要原因之一。尽管缺乏基于证据的预防RGT的指导，但抗凝预防措施已被广泛采用。本次调查的目的是收集欧洲在肾脏移植中应用的多种抗凝预防策略的见解。一项包含22个问题的在线调查，面向肾脏移植专业人员，通过电子邮件和欧洲器官移植协会的平台进行分发。共收到75份回复（来自21个国家，51个中心）：其中75%的受访者拥有超过10年的临床经验，64%为外科医生，29%为肾科医生，4%为泌尿科医生。75%的中心拥有书面抗凝管理方案。在8个（占16%）中心，受访者对书面方案的存在与否存在分歧。78%的受访者偏好抗凝预防措施，无论现有抗凝管理方案如何。92%的受访者表示，预期出血风险是术前终止长期抗凝治疗的主要原因。在手术过程中，32%的受访者对特定病例使用未分馏肝素（400-10,000国际单位，中位数为5000）。尽管在肾脏移植中普遍偏好围手术期抗凝预防，但欧洲在预防措施的类型、时机和剂量方面存在较大差异，这很可能是因为高质量研究数量不足。有必要进行进一步研究，以制定更好的指导方针。