Transfusion, erythropoiesis-stimulating agent therapy, and kidney transplant wait time

Robert M Perkins,H Lester Kirchner,Rajesh Govindasamy

doi:10.4236/ojim.2012.21001

Abstract

Aim: Anemia is highly prevalent among patients wait-listed for renal transplant, and management with blood transfusion or erythropoietin stimulating agents may impact transplant wait time. The purpose of this study was to examine the impact of blood transfusion and erythropoiesis stimulating agent therapy on renal transplant wait time. Methods: We retrospectively analyzed all adult patients listed for first deceased donor kidney transplantation at two transplant centers in Central Pennsylvania between 2004 and 2008. The exposures of interest were blood transfusion and erythropoietin stimulating agent therapy. Cox proportional hazards were used to model time to deceased donor kidney transplant. Results: Among 407 patients listed for transplant, 84 received a deceased donor kidney during a median follow-up of 26.3 months. In an adjusted Cox proportional hazards model, with erythropoiesis stimulating agent and transfusion both treated as time-dependent exposures, UNOS inactive status at listing date (hazard ratio [HR] 0.81; 95% CI 0.73 - 0.89; P < 0.001) and transfusion during the wait list period (HR 0.27; 95% CI 0.11 - 0.69; P = 0.01) independently predicted longer transplant wait time. Erythropoiesis stimulating agent use prior to or after transplant wait listing date did not independently predict wait time. Conclusion: Blood transfusion while waitlisted for kidney transplant is strongly associated with prolonged wait time.

Highlights

Renal transplantation is the preferred therapy for patients with end-stage renal disease (ESRD) because it is associated with better long-term survival, [1] improved qual-ity of life, and lower costs [2]
In an adjusted Cox proportional hazards model, with erythropoiesis stimulating agent and transfusion both treated as time-dependent exposures, United Network for Organ Sharing (UNOS) inactive status at listing date and transfusion during the wait list period (HR 0.27; 95% CI 0.11 - 0.69; P = 0.01) independently predicted longer transplant wait time
Along with pregnancy and prior organ transplant, transfusion of red blood cells can contribute to the elevation in panel reactive antibody (PRA) among renal transplant candidates [8], which suggests that transfusion might be associated with longer transplant wait time

Summary

Introduction

Renal transplantation is the preferred therapy for patients with end-stage renal disease (ESRD) because it is associated with better long-term survival, [1] improved qual-ity of life, and lower costs [2]. For potential deceaseddonor renal transplant recipients, time spent on the transplant wait list has increased during the past decade. For those patients listed in 2009, it is expected that median wait time will approach 4 years, an increase of nearly 25% compared with wait times for patients listed in 2004 [3]. A longer renal transplant wait time— when receiving maintenance hemodialysis—is associated with an increased risk of cardiovascular and other morbidity and shorter graft and patient survival after transplantation [4,5]. Several factors have been consistently associated with longer renal transplant wait times, including non-white race, B and O blood types, and immunologic sensitization, as reflected by an elevated panel reactive antibody (PRA) level [6,7]. Along with pregnancy and prior organ transplant, transfusion of red blood cells can contribute to the elevation in PRA among renal transplant candidates [8], which suggests that transfusion might be associated with longer transplant wait time

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Conclusion