Blood transfusion and the risk for infections in kidney transplant patients.

David Massicotte-Azarniouch,Manish M Sood,Greg A Knoll,Michaël Chassé,Dean A Fergusson,Alan Tinmouth,Frank Jmf Dor

doi:10.1371/journal.pone.0259270

David Massicotte-Azarniouch, Manish M Sood + Show 5 more

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https://doi.org/10.1371/journal.pone.0259270

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Abstract

Receipt of a red blood cell transfusion (RBCT) post-kidney transplantation may alter immunity which could predispose to subsequent infection. We carried out a single-center, retrospective cohort study of 1,258 adult kidney transplant recipients from 2002 to 2018 (mean age 52, 64% male). The receipt of RBCT post-transplant (468 participants transfused, total 2,373 RBCT) was analyzed as a time-varying, cumulative exposure. Adjusted cox proportional hazards models were used to calculate hazard ratios (HR) for outcomes of bacterial or viral (BK or CMV) infection. Over a median follow-up of 3.8 years, bacterial infection occurred in 34% of participants at a median of 409 days post-transplant and viral infection occurred in 25% at a median of 154 days post-transplant. Transfusion was associated with a step-wise higher risk of bacterial infection (HR 1.35, 95%CI 0.95-1.91; HR 1.29, 95%CI 0.92-1.82; HR 2.63, 95%CI 1.94-3.56; HR 3.38, 95%CI 2.30-4.95, for 1, 2, 3-5 and >5 RBCT respectively), but not viral infection. These findings were consistent in multiple additional analyses, including accounting for reverse causality. Blood transfusion after kidney transplant is associated with a higher risk for bacterial infection, emphasizing the need to use transfusions judiciously in this population already at risk for infections.

Highlights

Over a median follow-up of 3.8 years, bacterial infection occurred in 34% of participants at a median of 409 days post-transplant and viral infection occurred in 25% at a median of 154 days post-transplant
Transfusion was associated with a step-wise higher risk of bacterial infection (HR 1.35, 95%CI 0.95–1.91; hazard ratios (HR) 1.29, 95%CI 0.92–1.82; HR 2.63, 95%CI 1.94– 3.56; HR 3.38, 95%CI 2.30–4.95, for 1, 2, 3–5 and >5 red blood cell transfusion (RBCT) respectively), but not viral infection
Blood transfusion after kidney transplant is associated with a higher risk for bacterial infection, emphasizing the need to use transfusions judiciously in this population already at risk for infections

Summary

Introduction

Kidney transplantation is the treatment of choice for end-stage kidney disease (ESKD) since it is associated with improved survival and quality of life compared to dialysis [1,2,3]. It is thought that a RBCT could contain immune suppressing substances which could impair cellular immunity and induce a state of anergy in the recipient [14,15,16,17] This immune down regulation was a key rationale for the use of pre-transplant blood transfusion to improve allograft outcomes, a practice that has fallen out of favour with more potent immunosuppressants and the recognized risk for sensitization [18]. This potential immunosuppressive effect merits further clarification in kidney transplant patients given their high exposure to RBCT, their immunosuppressed status and high incidence of infection [19]. Receipt of a red blood cell transfusion (RBCT) post-kidney transplantation may alter immunity which could predispose to subsequent infection

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