TY  - JOUR
AU  - Bauza, Maria V. Fonseca
AU  - Dubin, Aimee H.
AU  - Agala, Chris B.
AU  - Toledo, Alexander H.
AU  - Szempruch, Kristen R.
AU  - Gerber, David A.
AU  - Rodriguez, Pablo Serrano
PY  - 2025
DA  - 2025/02/27
TI  - Management of Atrial Fibrillation after Kidney Transplant: Do We Need a New Metric?
JO  - OBM Transplantation
SP  - 238
VL  - 09
IS  - 01
AB  - To evaluate the bleeding risk associated with anticoagulation (AC) in kidney transplant patients with post-operative atrial fibrillation (AF). We conducted a retrospective analysis of all adult kidney transplant recipients performed from October 2012 to February 2019 at our institution, the University of North Carolina at Chapel Hill, which accounted for 428 transplants. Variables assessed included AF occurrence, AC use, bleeding complications, stroke and bleeding risk stratification in AF (determined using CHA2DS2-VASc and HAS-BLED scores respectively), and renal function. Adjusted odds ratios, relative risk and linear estimates and their 95% confidence intervals and corresponding p-values were estimated to identify risk factors of interest using multivariate logistic regression and generalized linear and linear models. Of the 428 kidney transplant patients analyzed, 6.8% (n = 29) developed AF, and 51.7% (n = 15) of these patients received AC. Among those on AC, 73.3% (n = 11) experienced bleeding complications, and 36.4% (n = 4) required medical intervention. AC use was associated with higher odds of post-transplant interventions (OR = 4.62, 95% CI: 1.63-13.13, p = 0.0041), including a return to surgery (OR = 7.34, 95% CI: 2.32-23.25, p = 0.0007). Higher HAS-BLED scores correlated with increased odds of intervention (OR = 1.61, 95% CI: 1.1-2.36, p = 0.0143). Patients on AC also had higher creatinine levels at discharge and increased odds of delayed graft function (OR = 3.27, 95% CI: 1.45-7.35, p = 0.0042), longer hospital stays, and increased readmission rates. No patients developed a stroke during follow-up. Kidney transplant recipients with AF who receive AC face substantial bleeding risks. While CHA2DS2-VASc and HAS-BLED scores are valuable for assessing patients with AF, they may be inadequate for managing AF in post-kidney transplant or post-surgical settings. This study is the first to evaluate the risk of AC and early post-operative bleeding in kidney transplant recipients with new-onset AF.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.2501238
DO  - 10.21926/obm.transplant.2501238
ID  - Bauza2025
ER  -