Thromboelastography (TEG) has been proven to be of significant value in the prediction of hyper- and hypocoagulable states for patients undergoing hepatic transplantation and coronary artery bypass graft surgery, however, its role is as-yet undefined in the prediction of clotting related complications of living-related renal transplantation, which may range from severe haemorrhage to thrombosis and failure of the renal allograft. TEG assessment of living related transplant recipients on induction may thus confer significant advantages in the context of diagnosis and management of occult clotting defects. A growing body of evidence suggests that TEG is superior to routine laboratory tests in guiding intra-operative coagulation management.

Aim of this study is to assess the potential applicability of perioperative thromboelastograph (TEG) in the early prediction of delayed graft failure and perioperative complications for living-related renal transplantation.

This single-centered, prospective study after approval by ethics committee of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India and written informed consent from the patients would be conducted over a period of one year in 30 living-related transplant patients. Warm ischaemic time would be kept negligible for the donated organs. Cold ischaemic time would be kept <2 hours. All patients would receive immunosuppression with tacrolimus 0.15 mg/kg/day for 2 days before transplant and mycophenolate 1000 mg bd on the day of transplant or at the start of pretransplant plasmapheresis. At surgery, allograft vascular anastomoses would be to the external/internal iliac vein and artery.

The results of all pre-operative haematology, biochemistry and radiological investigations would be recorded from 24 h prior to surgery upto a period of 7 days postoperatively.

A pre-operative central venous 5-ml blood sample would be drawn prior to the commencement of surgery for the purposes of thromboelastographic analysis and immediately processed by a trained senior perfusionist. A postreperfusion blood sample would be similarly drawn at the point of abdominal closure  and processed for comparison. A postoperative blood sample would be drawn on first postoperative day and processed for comparison.

One-year follow-up data including graft failure, serum creatinine levels, haemorrhagic and thrombotic graft  complications, incidences of rejection and venous thrombo-embolism would be recorded and analysed in the context of TEG data findings. Exclusion criteria would be patient’s refusal, individuals receiving allografts with multiple renal arteries or cases where laparoscopic donor nephrectomy was converted to open nephrectomy.

Statistical analysis would be done by SPSS software version 20.0. Quantitative data would be analysed with student t-test and qualitative data using chi-square and fisher-exact test. Significance would be attributed at P <0.05.