Results of Antithrombin III Treatment in Patients after Kidney Transplantation

Priv.-Doz. Dr. J. Schrader, Abteilung für Nephrologie, Universitätsspital, Robert-Koch-Strasse 40, D-3400 Göttingen (FRG) Dear Sir, Acute local intravascular coagulation is common in kidney transplant rejection [1–3]. Mostly in hyperacute rejection the pathogenetic importance of intravascular coagulation in kidney damage could be demonstrated [4, 5]. It has also been shown that antithrombin III (AT III) levels rose during the rejection process before clinical signs were noticed [6]. The raised levels of AT III during transplant rejection might reflect an acute phase response to the rejection process. Also, as the role of this protein is to protect against intravascular thrombosis, the raised levels early in and throughout the rejection period might reflect a response by the body to supply an enhanced antithrombotic potential to protect the blood supply of the transplanted organ by diminishing glomer-ular fibrin deposits [6]. According to this a therapy with AT III could imitate the natural defense reaction and could have a protective effect on kidney function. Therefore, the effect of AT III treatment had been studied in 51 patients undergoing kidney transplantation. In 14 patients the vascular system of the transplanted kidney was perfused with 2,000 U AT III (Kybernin; Behring, Marburg) before implantation. In 15 patients additionally to the AT III perfusion a daily intravenous AT III treatment of 1,000 U was performed until the onset of an urine flow above 500 ml/day, while the remaining 22 patients served as a control group. The shortest duration of intravenous treatment was 3 days, the maximum was 28 days. The mean duration of AT III therapy was 10.3 ± 8.1 days. The three patient groups did not differ in age, sex, underlying renal diseases, warm and cold ischemia times and in the numer of mismatches. In table 1 the duration of oligoanu-ria, the number of necessary hemofiltrations after transplantation and the number of detected transplant rejections are shown. The duration of oligoanuria and the Table I. Number of days of oligoanuria, of necessary hemofiltrations and of rejection episodes after kidney transplantation in the 3 groups; in the lower part mean values of AT III during the first 28 days after transplantation are shown (*p < 0.05). Control AT III AT III group perfusion perfusion (n = 22) (n = 14) and i.v. treatment (n = 15)