Risk factors for postoperative bleeding in ABO‐incompatible kidney transplantation

The outcome of ABO ‐incompatible kidney transplantation ( ABO i KT ) has improved and is now comparable to that of ABO ‐compatible kidney transplantation ( ABO c KT ). However, ABO i KT may be associated with a higher risk of postoperative bleeding than ABO c KT . Methods Seventy patients with ABO i KT were divided into a bleeding group (n = 9) and non‐bleeding group (n = 61). General, immunologic, and hematological characteristics were compared to identify the risk factors for postoperative bleeding. Results Pre‐emptive transplantation and a high pre‐transplant blood urea nitrogen level were more common in the bleeding group (p = 0.0176 and 0.023, respectively). A high anti‐ ABO antibody titer after plasmapheresis (median, ≥16; p = 0.0226), a low platelet count of ≤100 000/mm 3 after plasmapheresis (p = 0.0289), a prolonged activated partial thromboplastin time (p = 0.0073), and impaired platelet function (p = 0.0274) were associated with an increased risk of bleeding after ABO i KT . Conclusion Postoperative bleeding after ABO i KT was difficult to control and increased the risk of immediate graft loss (p = 0.015). Our results suggest that changes in coagulability associated with uremia and plasmapheresis may increase the risk of bleeding after ABO i KT .