Abstract
Background: Patients undergoing kidney transplantation (KT) often receive red blood cell (RBC) transfusion during admission for KT which may increase the risk of allosensitization. The association between peri-transplant RBC transfusion and graft survival was evaluated using a nationwide cohort. Methods: This retrospective study analyzed 13,871 patients who underwent KT in Korea between 2007 and 2015. The outcomes were graft failure rate and overall patient survival depending on the amount of RBC transfusion. Results: The overall graft failure rate was 15.5%. Compared to the graft failure rate of 13.5% in the no transfusion group, the graft failure rate was 15.4% in the 1–2 units group (sHR 1.06 (95% CI 0.97–1.17), p = 0.216), 21.4% in the 3–5 units group (sHR 1.39 (1.21–1.61), p < 0.001), and 35.3% in the 6 or more units group (sHR 2.20 (1.70–2.85), p < 0.001). The overall survival rate was 97.5% in the no transfusion group, compared to 95.9% in the 1–2 units group (HR 1.50 (1.22–1.83), p < 0.001), 92.0% in the 3–5 units group (HR 2.43 (1.87–3.15), p < 0.001), and 67.5% in the 6 or more units group (HR 6.81 (5.03–9.22), p < 0.001). Conclusions: Peri-transplant RBC transfusion was independently associated with the increased risk of renal allograft failure and death in KT patients.
Highlights
Patients undergoing kidney transplantation (KT) often receive red blood cell (RBC) transfusion during admission for KT which may increase the risk of allosensitization
Compared to the graft failure rate of 13.5% in the no transfusion group, the graft failure rate was 15.4% in the 1–2 units group (sHR 1.06, p = 0.216), 21.4% in the 3–5 units group (sHR 1.39 (1.21–1.61), p < 0.001), and 35.3% in the 6 or more units group (sHR 2.20 (1.70–2.85), p < 0.001)
Peri-transplant RBC transfusion was independently associated with the increased risk of renal allograft failure and death in KT patients
Summary
Kidney transplantation (KT) is the treatment of choice for end-stage renal disease (ESRD) with clear advantages over renal replacement therapy in survival and quality of life [1]. Blood transfusion prior to KT was common practice [5] until the early 1980s with intentions to improve graft survival rates through immunosuppression by transfused white blood cells [6]. Following increased graft survival due to improved human leukocyte antigen (HLA) matching and more effective immunosuppressive agents, the benefit of peritransplant transfusion in KT became insignificant [7]. The impact of peri-transplant transfusion on the renal allograft outcome remains unclear. Studies evaluating the relationship between peri-transplant transfusion and the renal allograft outcome have shown conflicting results [10,11]. To evaluate the association between peri-transplant red blood cell (RBC) transfusion and graft survival, a nationwide cohort study using the National Healthcare Insurance Service (NHIS) database was conducted
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