How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?

I am not aware of published systematic reviews, risk models, or evidence-based guidelines for post-operative prophylaxis in renal transplant patients. Given both increased risk for VTE and bleeding, it is not surprising that there is a large variation in practice (for relatively recent survey on the practice patterns see: van den Berg et al., PMID 34872084; this paper also cites some consensus guidelines and small RCTs):

Most physicians try to individualize the approach based on usual factors :

• Details of prior VTE event (timing, provoking factors)
• Other VTE risk factors (age, obesity, immobility, etc.)
• Bleeding risk factors
• Type of transplant procedure (living vs deceased donor)

Then if one estimates that VTE risk>bleeding (which most often is the case) most of us suggest pharmaco-prophylaxis (with low threshold for stopping it in the case of suspected bleeding).