Hemostatic changes and antithrombotic management in kidney transplantation

Kidney transplantation is the best treatment option for patients with end-stage kidney disease. Nowadays, renal graft thrombosis (RGT) is the most prominent cause for early graft loss, as immunological reasons have virtually vanished due to advances in immunosuppression and immunological techniques. Because treatment and restoration of function in case of established RGT is often unsuccessful, measures to prevent RGT by for example antithrombotic management are pivotal. There are, however, still uncertainties regarding the optimal antithrombotic management strategy, due to pathophysiological changes in the hemostatic system of end-stage kidney disease patients that cause the paradoxical situation of a simultaneously increased thrombosis and bleeding risk. The work that is presented in this thesis aims to provide a better framework for appropriate antithrombotic therapy to prevent renal graft thrombosis in kidney transplant recipients. In order to do so, we performed a survey to obtain a broad view on the applied antithrombotic management strategies throughout Europe and studied the actual incidence and additional risk factors of RGT and postoperative bleeding. Additionally, we aimed to gain a better understanding of the hemostatic changes in kidney transplant recipients and the graft, with emphasis on the distinction between different dialysis modalities and development of microthrombi. Furthermore, we recognize that advancing the field can be subject to developments on a more societal level. Therefore, this thesis also contains two bibliometric analyses elucidating on recent academic developments in transplantation research worldwide, which can potentially affect the field of transplantation research in either a positive or negative way.