PMID- 9774117
OWN - NLM
STAT- MEDLINE
DCOM- 19981021
LR  - 20190815
IS  - 1523-6838 (Electronic)
IS  - 0272-6386 (Linking)
VI  - 32
IP  - 4
DP  - 1998 Oct
TI  - Changes in coagulation and fibrinolysis in the postoperative period immediately 
      after kidney transplantation in patients receiving OKT3 or cyclosporine A as 
      induction therapy.
PG  - 575-81
AB  - Different immunosuppressive agents, in particular OKT3, have been implicated as 
      causative factors in the risk for renal thrombosis in the period immediately 
      after kidney transplantation. Also, in different types of vascular surgery, a 
      state similar to hypercoagulation has been reported. To assess the extent to 
      which OKT3, cyclosporine A (CsA), and surgery itself affect coagulation and 
      fibrinolysis, a study was conducted of 20 patients divided into two groups: group 
      A, 10 patients received OKT3 (first dose during the induction of anesthesia); and 
      group B, 10 patients received CsA (first dose at least 2 hours before 
      transplantation). Basal determinations and determinations at 2, 4, and 24 hours 
      after the induction of anesthesia were made. No differences were found between 
      the groups with respect to the clinical and usual coagulation parameters. The 
      following were studied in both groups: (1) markers of coagulation activity 
      (prekallikrein [PKK] levels and formation of thrombin-antithrombin complexes 
      [TATc]), (2) inhibitors and suppressors of hemostasis (antithrombin III [AT-III] 
      and protein C [PC] activity), (3) markers of fibrinolysis activation (levels of 
      plasminogen [PLG] and of alpha2-antiplasmin [alpha2-APL]), and (4) markers of 
      endothelial damage (tissue plasminogen activator [TPA] and thrombomodulin [TMD]). 
      In both groups, an important formation of TATc was observed early, together with 
      a decrease in PKK levels and consumption of both AT-III and PC, which reached 
      their lowest levels at 24 hours. This points to an activation of coagulation 
      through the intrinsic route and a secondary consumption of hemostasis inhibitors, 
      both possibly caused by surgery. A consumption of PLG and alpha2-APL was also 
      observed, reflecting stimulation of the fibrinolytic system and a physiological 
      response to the activation of coagulation. A greater release of endothelial TPA 
      was only observed in the patients receiving OKT3 (P < 0.0001), possibly signaling 
      endothelial activation. It is concluded that surgical stress could be the major 
      factor triggering the alterations seen in hemostasis and their possible 
      consequences.
FAU - Deira, J
AU  - Deira J
AD  - Service of Nephrology, University Hospital, Salamanca, Spain.
FAU - Alberca, I
AU  - Alberca I
FAU - Lerma, J L
AU  - Lerma JL
FAU - Martin, B
AU  - Martin B
FAU - Tabernero, J M
AU  - Tabernero JM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Blood Coagulation Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Muromonab-CD3)
RN  - 83HN0GTJ6D (Cyclosporine)
SB  - IM
MH  - Adult
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Factors/drug effects
MH  - Cyclosporine/*adverse effects
MH  - Female
MH  - Fibrinolysis/drug effects
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects
MH  - Kidney Diseases/chemically induced
MH  - Kidney Transplantation/*adverse effects/methods
MH  - Male
MH  - Middle Aged
MH  - Muromonab-CD3/*adverse effects
MH  - Postoperative Complications/*chemically induced
MH  - Renal Artery Obstruction/chemically induced
MH  - Thrombosis/chemically induced
MH  - Time Factors
EDAT- 1998/10/17 00:00
MHDA- 1998/10/17 00:01
CRDT- 1998/10/17 00:00
PHST- 1998/10/17 00:00 [pubmed]
PHST- 1998/10/17 00:01 [medline]
PHST- 1998/10/17 00:00 [entrez]
AID - S027263869800273X [pii]
AID - 10.1016/s0272-6386(98)70019-8 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 1998 Oct;32(4):575-81. doi: 10.1016/s0272-6386(98)70019-8.