Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.
ABSTRACT It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.
This was a single center, national, retrospective cohort study. Data was collected on patients who received kidney transplants over a 14-year period (n = 2,013). The primary outcomes were graft survival and mortality in patients who received blood transfusions in the perioperative period compared to those who did not.
Patients who received blood transfusions had lower hemoglobin levels, were more likely to be male, and had higher rates of delayed graft function compared to those who did not receive a transfusion. The one year graft survival of those transfused was 83% compared to 94% in those not transfused (p = < 0.0001). Adjustment for confounding showed that the receipt of a blood transfusion remained associated with increased graft loss. Hemoglobin levels prior to transfusion did not have an influence on graft outcome.
Perioperative blood transfusion is associated with reduced long-term graft survival.
- SourceAvailable from: europepmc.org[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Given the unpredictable timing of deceased donor organs and the need for blood transfusion, this study was carried out to determine the rate and risk factors for transfusion in order to identifying a low-risk cohort in the face of a critical blood shortage. METHODS: This retrospective chart review examined 306 consecutive deceased solitary kidney transplant recipients from January 2006 to August 2012. RESULTS: Records show that 80 (26.1%) patients were transfused with a total of 300 units (0.98 units/transplant) during their first hospital stay. Transfusions were higher in patients on warfarin (8/14, 57%, 5.1 units/transplant) and antiplatelet agents (46/136, 33.8%, 1.1 unit/transplant) compared to no anticoagulants (74/156, 16.7%, 0.47 units/transplant). In a multivariable logistic regression analysis warfarin (odd ratio (OR) 8.2, 95% confidence interval (CI) 2.5--27, P=0.001), antiplatelet agents (OR 2.9, 95% CI 1.6--5.3, P=0.001), recipient age >=55 years (OR 2.2, 95% CI 1.2--3.9, P=0.008), recipient male (OR 0.36, 95% CI 0.2--0.64, P=0.001) and preop hemoglobin >=115 g/L (OR 0.32, 95% CI 0.18--0.57, P<0.001) were independent predictors of blood transfusion. Lower bleeding cohorts with transfusion rates <5% could not be identified. CONCLUSION: The need for blood is significantly higher in subjects on either warfarin or antiplatelet agents. These patients might be avoided if kidney transplantation is to occur during a critical blood shortage. Unfortunately even patients not on anticoagulation are at some risk.Transplantation research. 04/2013; 2(1):4.