Blood Transfusion Service Research Articles

Distribution of ABO and Rh (D) Blood Groups and their Genotypes in Amran Governorate, Yemen

Background: The ABO and Rh blood group system is essential for blood bank inventory, blood transfusion services, and organ transplants. Relatively very little data is available about ABO and Rh (D) blood groups distributions in the Amran governorate. Therefore, this study aimed to determine the distribution of ABO and Rh (D) blood group and their genotypes in the Amran governorate, Yemen. Methods: A cross-sectional prospective and retrospective study was carried out from January 2020 to December 2021, on 1949 volunteer blood donors; 414 medical students were obtained from Amran University and 1535 from clinical records in the blood bank of Maternity and childhood hospital at Amran Governorate. The ABO and RhD grouping was done by using commercially available monoclonal antibodies (anti-A, anti-B, and anti-D) by slide methods. The allele and genotype frequency of the donors was determined by the Hardy-Weinberg equilibrium assumption. Descriptive statistics were analyzed using the SPSS program. The difference between the observed and expected frequency was tested by an online Chi-square calculator. A P-value of <0.05 was considered statistically significant. Results: Out of 1949 participants; were 78.8% of hospital donors, 92.2% of males, and 63.5% of rural areas. Blood group O was the most prevalent (51.2%), followed by A (31.5%), B (13.9%), and AB (3.5%) with statistically significant differences (P= 0.002). The Rh (D) positive was present in 86.8% of participants and 13.2% were Rh (D) negative. Moreover, the allele frequencies were in the order of (IO > IA > IB > AB), where (IO i = 0.513, IA = 0.313, IB = 0.138, and AB= 0.035). While the Rh(D) and d allelic frequencies were 0.868 and 0.132, respectively. Also, there was no statistically significant difference between observed and expected allele and genotype frequency (P-value >0.05). Conclusion: The frequency of distribution of ABO and Rh (D) blood group and their genotypes among the study population was found to be similar to those reported from most Asian populations. This crucial information may be helpful in planning for future health challenges, particularly planning with regard to blood transfusion services.

Putting blood donors at the heart infectious disease surveillance

Abstract Issue The emergence of SARS-CoV-2 brought with it an urgent need to generate accurate and real-time surveillance data. The Irish Blood Transfusion Service (IBTS), along with many blood establishments worldwide undertook SARS-CoV-2 serosurveillance studies using residual blood donor serum. This response highlighted the role that blood donors can play in informing public health policy. Description In September 2020 the IBTS undertook a SARS-CoV-2 seroprevalence study using blood donor specimens to track the ‘first-wave’ of the COVID-19 pandemic in Ireland. We utilised our operational capacity for sample collection and screening to quickly generate seroprevalence data. In 2021, the newly established National Serosurveillance Program (NSP) in Ireland invited the IBTS to collaborate on a SARS-CoV-2 serosurveillance study in blood donors which has continued into 2023. Results This response has led to an enhanced relationship between the IBTS and public health in Ireland and has highlighted a possible future role for the IBTS in providing ‘real-time’ seroprevalence data to policy-makers. This data can be used to inform decision-making in relation to infection prevention and control strategies including vaccination policy. Lessons This practice highlights the role that blood establishments can play in informing public health policy and indicates that this role could be expanded in the future in the cases of both emerging infections and vaccine preventable diseases. Blood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to infections on a national level and with the opportunity for longitudinal sampling of returning donors. Key messages • The relationship between blood establishments and public health should be further explored in the future to support infectious disease surveillance programmes. • Blood donor studies can provide vital baseline data of healthy populations.

Evaluation of the accuracy of the Asanté assay as a point-of-care rapid test for HIV-1 recent infections using serum bank specimens from blood donors in South Africa, July 2018 - August 2021.

Point-of-care (POC) rapid recency testing can be used as a cost-effective tool to identify recently infected individuals (i.e. infected within the last 12 months) in near-real time, support epidemic control and identify hotspots for transmission as part of recent infection surveillance. To evaluate the performance of the Asanté (HIV-1) rapid recency assay as a POC rapid test among blood donors in South Africa (SA). The study was a cross-sectional and validity study of the Asanté HIV-1 Rapid Recency Assay performed on 715 consecutively archived plasma donor specimens from the SA National Blood Services to determine their recency and established HIV infection status. ELISA and rapid assays for HIV antibody detection were used as the reference-testing standard for confirming an infection, while the Maxim HIV-1 limiting antigen (LAg) avidity assay was used as a reference for comparing HIV recency status. Validity tests (sensitivity, specificity, negative and positive predictive values) and Cohen-Kappa tests of the agreement were conducted to compare the Asanté HIV-1 rapid recency assay results with the reference tests. Of the 715 studied blood samples, 63.1% (n=451/715) were confirmed to be HIV-positive based on the reference standard. The sensitivity and specificity of the Asanté HIV-1 rapid recency assay in diagnosing established HIV infection compared to the ELISA were 98.4% (95% CI 96.7 - 99.3) and 99.6% (95% CI 97.6 - 100), respectively. Compared with HIV rapid assay, the sensitivity and specificity of the Asanté HIV-1 rapid recency assay was 98.7% (95% CI 97.0 - 99.4) and 99.2% (95% CI 97.1 - 100), respectively. Of the 451 HIV-positive blood samples, 43% were confirmed as recent HIV infections by the Maxim HIV-1 LAg avidity assay. There was high agreement between the Asanté HIV-1 rapid recency assay and the Maxim HIV-1 LAg avidity assay (94.1%, k=0.879, p<0.0001). The sensitivity and specificity of the Asante HIV-1 assay was 89.4% (95% CI 84.0 - 93.0) and 97.7% (95% CI 94.8 - 99.0), respectively. The Asanté HIV-1 rapid recency assay test results demonstrated high accuracy (>90%) compared with the HIV ELISA and rapid assays for determining established infection and the Maxim HIV-1 LAg avidity assay for classifying recent HIV-1 infections. The assay's sensitivity for established infections was below the World Health Organization criteria (<99%) for POC devices. The Asanté HIV-1 rapid recency assay can be used to distinguish between recent and long-term infections, but may not be considered a POC test for determining HIV infection.

Implementation of Indian National plasma policy at blood bank of a tertiary care hospital: A step towards strengthening of blood transfusion services

IntroductionThe World Health Organization has advocated that every country should make its own policy for ensuring safe and adequate supply of plasma derived medicinal products through mobilization and usage of locally collected plasma. The National Plasma Policy (NPP) of India was published in 2014 with a dual objective to achieve self sufficiency in the production of plasma derived medicinal products and at the same time to augment the component preparation facilities in India and overall upliftment of blood transfusion services in the country. Thus the present study was done to access the impact of implementation of NPP in our blood bank on the blood transfusion services in our hospital. Materials and methodsThe present study was a retrospective observational study conducted in the department of transfusion medicine of a tertiary care hospital in India involving analysis of data from 1st January 2019 till 31st December 2022. For the purpose of data analysis the time period was divided into 2 periods: (i) Pre-NPP implementation period from 1st January 2019 till 31st December 2020; (ii) Post-NPP period from 1st January 2021 till 31st December 2022. The following parameters were compared for the two periods: (i) component preparation rate; (ii) percentage of component therapy; (iii) total number of FFP transferred to plasma fractionation centers; (iv) total amount of exchange amount generated in lieu of transferred FFP to plasma fractionation centers. ResultsThe component preparation rate after NPP implementation was significantly higher as compared to the pre NPP implementation period (93.81% vs 56.70%; p = 0.007). The percentage of component therapy in the patients was also significantly higher as compared to the pre-NPP implementation period (97.9% vs 73.6%; p = 0.005). The total amount of exchange amount generation in Indian rupee (INR) after NPP implementation was INR 1419462 (15835€) while it was INR 636898 (7105€) in the pre NPP implementation period. This amount was utilized for procurement of various blood bank equipment, in addition 2 lab technicians were also hired for the blood bank. ConclusionsThe implementation of NPP resulted in upliftment of blood transfusion services in our hospital. Other low and middle income countries can benefit from implementation of similar plasma policy in their countries.

Evaluation of Prevalence of Hepatitis E Clinical Markers among Donors in Estonia.

Hepatitis E virus (HEV) is now considered the most common cause of acute hepatitis worldwide. There are no published data about the prevalence of antibodies to HEV and RNA in donor sera in Estonia, and this precludes planning measures for preventing HEV proliferation through blood transfusion services. Here, were report data from an analysis of 1002 sera on the prevalence of anti-HEV IgG and IgM and the viral RNA. The antibodies were found in 48 donor sera (4.8%); of these, 40 (4%) harbored anti-HEV IgG, 15 (1.5%) contained anti-HEV IgM, and 7 donors had anti-HEV antibodies of both classes simultaneously. HEV RNA was not detected in any blood serum. Statistical associations of infection risk factors (gender, age, travel in the last six months, contact with pigs and/or wild boars in the last six months, consumption of thermally unprocessed/raw pork or boar meat, raw/unfiltered tap water or water from natural sources, unpasteurized farm dairy products, and unwashed berries and/or vegetables) were assessed. None of the listed factors were found to be associated with a higher or lower risk of anti-HEV antibody presence. At the same time, an increasing share of anti-HEV IgG carriers with age was found. The absence of HEV RNA in the analyzed donor plasma samples proves that HEV acute infection prevalence in Estonia does not exceed the average level of European countries. There is no urgent necessity to enter a requirement for a total screening of blood plasma for HEV RNA prevalence in Estonia.

Prevalence and incidence of transfusion-transmissible infections among blood donors in Malawi: A population-level study.

Voluntary non-remunerated blood donors (VNRBDs) are essential to sustain national blood supplies. Expanding testing capacity for the major transfusion-transmitted infections (TTI) is crucial to ensure safe blood products. Understanding trends in TTIs can inform prioritisation of resources. We conducted a retrospective cohort data analysis of routine blood donation data collected from VNRBDs by the Malawi Blood Transfusion Service from January 2015 to October 2021. Variables included age, occupation; and screening results of TTIs (HIV, Hepatitis B and C, and syphilis). We estimated both prevalence and incidence per person-year for each TTI using longitudinal and spatial logistic regression models. Of the 213 626 donors, 204 920 (95.8%) donors were included in the final analysis. Most donors (77.4%) were males, baseline median age was 19.9 (IQR 18.0, 24.1), 70.9% were students, and over 80.0% were single at first donation. Overall TTI prevalence among donors was 10.7%, with HBV having the highest prevalence (3.4%), followed by syphilis (3.3%), then HIV (2.4%) and HCV (2.4%). Incidence per 1000 person-years for syphilis was 20.1 (19.0, 21.3), HCV was 18.4 (17.3, 19.5), HBV was 13.7 (12.8, 14.7), and HIV was 11.4 (10.6, 12.3). We noted geographical variations with the northern region having lower rates of both prevalence and incidence compared to central and southern regions. The individual TTI prevalence and incidence rates from this study are consistent with Southern African regional estimates. By identifying geographical variations of TTI prevalence and incidence, these findings could potentially inform prioritisation of blood collection efforts to optimise blood collection processes.

Blood Transfusion Request and Utilization: The Trend in a Tertiary Health Care Centre in North Central Nigeria

Background: An effective blood transfusion service is anchored on an adequate supply of safe blood and its components as well as its accessibility and appropriate clinical use. There is a contrast in blood supplies and utilization between the high, middle and low-income countries necessitating the formulation of appropriate modalities to ensure judicious use of blood while minimizing wastage.&#x0D; Aims: This study was aimed at assessing the blood transfusion request trend in our institution and its utilization with the intent of curtailing the wastage of safe blood for transfusion.&#x0D; Study Design: It is a retrospective study.&#x0D; Place and Duration of Study: Jos University Teaching Hospital Blood Bank from January 2022 to December 2022.&#x0D; Methodology: Appropriately filled blood transfusion request forms of the Jos University Teaching Hospital compared with the blood bank In-house records from January 2022 to December 2022 were reviewed. Request dates, requesting Department, Unit or Specialty, indications for request, Number of units requested, and number eventually utilized were used to determine blood transfusion indices which are indicative of efficient and significant blood use.&#x0D; Results: Eight thousand, five hundred forty-eight (8,548) blood transfusion request forms from the blood bank and patients' folders were reviewed and compared with the Blood Bank's in-house records. Requests for blood transfusion for over 460 indications were received from twenty-six (26) departments and units. There was a general Crossmatch: Transfusion ratio (C: T) of 1.7 with a transfusion index (TI) of 1.2 and transfusion probability (TP) of 48.0%.&#x0D; Conclusion: Transfusion requests were characterized by low utilization across departments and units. This calls for the establishment of a transfusion protocol for the determination of blood volume required for every indication so that this limited commodity will be made available and accessible when needed.

P‐TS‐85 | The Rapid Expansion of the Hemoglobinopathy Patient Population in Ireland: Impact on Hospital and the National Blood Services

P‐TS‐85 | The Rapid Expansion of the Hemoglobinopathy Patient Population in Ireland: Impact on Hospital and the National Blood Services

Seroprevalence with epidemiological determinants of hepatitis C virus and Treponema pallidum infection in blood donors of a teaching hospital in southwest Punjab, India: A 5-year study

ABSTRACT Background: A high seroprevalence of various transfusion-transmitted infections (TTIs) in donated blood is the main safety concern, especially in low- and middle-income countries. As per the World Health Organization (WHO) recommendation, all blood donations must be tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum infection, and malaria, which mainly comprises the major bulk of TTIs. Aims: The purpose of this study is to observe the seroprevalence of hepatitis C virus and Treponema pallidum infection over the period of 5 years in blood donors of our blood center along with their epidemiological determinants with respect to age, sex, residence, occupation, and type of donors Materials and Methods: Retrospective study was conducted for the period of 5 years, from 1st January 2017 to December 2021, estimating the seroprevalence of hepatitis C and Treponema pallidum infection in the blood donors along with their epidemiological determinants Results: Out of 19,689 donations in 5 years, 690 (3.50%) units were positive for transfusion-transmissible infections with 1.67% donors seropositive for HCV, 1.23% for Treponema pallidum infection, 0.42% for HBV, and 0.18% for HIV. The prevalence of TTIs was found to be highest in 2020 (4.52%) and least in 2017 (2.57%). Out of a total of 330 HCV cases detected in 5 years, 84.85% of cases were seen in voluntary donors. Rural donors constituted 71.21% of cases. The majority of cases were seen in the age group of 18–30 years, i.e., 61.82%, and a maximum number of cases were seen in the farmers (31.21%), followed by laborers and construction workers (21.21%). Out of a total of 242 cases of Treponema pallidum infection, 84.29% were seen in voluntary blood donors. Demographic data showed 70.24% of cases in rural donors. Occupational data revealed a maximum number of cases in farmers (34.29%), followed by laborers (21.90%). Conclusion: Higher seroprevalence of HCV and Treponema pallidum infection in our region as compared with other areas is a matter of great concern about the growing infection rate of these in our area. Stringent use of donor selection criteria and more vigorous donor screening is utmost need of the hour for reducing the burden of TTIs in blood transfusion services.

Rare blood group registry in India-current challenges and future perspectives.

Patients who require blood from rare blood group donors present great challenges even to the most advanced healthcare delivery system. It is most challenging to supply blood for a patient with an antibody to an antigen of high prevalence. The blood donor lacking the corresponding antigen would have an occurrence rate of less than one in 1,000. The International Rare Donor Panel was established in 1965, but since then there has been gross underrepresentation of South Asian countries, including India. There are several challenges to starting a rare blood group donor program in India that include technical, logistical, and administrative limitations. But the main limiting factors are poor availability of trained resources, lack of awareness, absence of antibody screening, inadequate number of laboratories with blood group genotyping facilities, and the decentralized nature of blood transfusion services. Despite that, there were several rare blood groups identified by Indian immunohematologists in the recent past. Recently, a transfusion genomic group has been established in collaboration with the clinical transfusion medicine specialists in India under the GUaRDIAN (Genomics for Understanding Rare Disease in India Alliance Network) initiative to address the domain of rare blood group genomics. Similarly, the National Institute of Immunohematology, Mumbai under the directive of the ICMR (Indian Council of Medical Research) has taken a step to start the RDRI (Rare Donor Registry of India). In this context, we explore the current challenges of setting-up a rare blood group registry in India and future goals from a developing nation's perspective.

All Expanded Criteria Donor Kidneys are Equal But are Some More Equal Than Others? A Population-Cohort Analysis of UK Transplant Registry Data.

Survival outcomes for kidney transplant candidates based on expanded criteria donor (ECD) kidney type is unknown. A retrospective cohort study was undertaken of prospectively collected registry data of all waitlisted kidney failure patients receiving dialysis in the United Kingdom. All patients listed for their first kidney-alone transplant between 2000-2019 were included. Treatment types included; living donor; standard criteria donor (SCD); ECD60 (deceased donor aged ≥60years); ECD50-59 (deceased donor aged 50-59years with two from the following three; hypertension; raised creatinine and/or death from stroke) or remains on dialysis. The primary outcome was all-cause mortality, with time-to-death from listing analyzed using time-dependent non-proportional Cox regression models. The study cohort comprised 47,917 waitlisted kidney failure patients, of whom 34,558 (72.1%) received kidney transplantation. ECD kidneys (n = 7,356) were stratified as ECD60 (n = 7,009) or ECD50-59 (n = 347). Compared to SCD, both ECD60 (Hazard Ratio 1.126, 95% CI 1.093-1.161) and ECD50-59 (Hazard Ratio 1.228, 95% CI 1.113-1.356) kidney recipients have higher all-cause mortality. However, compared to dialysis, both ECD60 (Hazard Ratio 0.194, 95% CI 0.187-0.201) and ECD50-59 (Hazard Ratio 0.218, 95% CI 0.197-0.241) kidney recipients have lower all-cause mortality. ECD kidneys, regardless of definition, provide equivalent and superior survival benefits in comparison to remaining waitlisted.

Establishment of a stable proficiency testing matrix in transfusion microbiology in South Africa.

All medical laboratories must participate in proficiency testing (PT) programmes to ensure high-quality results. Proficiency testing samples mimic clinical samples; however, PT programmes for detection of bacteria in blood products are not routinely performed due to unavailability of matrix-equivalent samples. The aim of this study was to develop and test a matrix-equivalent PT programme using blood products as the basis matrix. A prospective cross-sectional study was conducted from April 2021 until June 2021, using 52 blood products comprising 36 pooled platelet and 16 red blood cell products at the South African National Blood Service PT laboratory in Gauteng. Products were manipulated into matrix-equivalent PT samples by spiking 42 products with known bacterial strains at specific concentrations and treating the remaining 10 products with preserving fluid containing antibiotics. The level of agreement between the researcher results and participating laboratories' results was assessed. Of the prepared matrices, 568 out of 572 (99%) were stable for 30 days. Bacteria could correctly be identified in spiked samples for up to 23 days. Samples treated with preserving fluid remained negative until day 30. For spiked samples, an average of 98% agreement (153/156) was achieved between the three participating laboratories when compared with the researcher's results; 100% agreement was achieved for unspiked samples. The kappa scores obtained from all tested variables presented with scores between 0.856 and 1.000, and the p-value was < 0.001 throughout. The developed PT matrix was therefore stable and suitable to be implemented in transfusion microbiology. This study demonstrated that a stable microbiology PT programme using platelets and red blood cells can be developed for use on bacterial detection analysers and could help to close the gap presented by unavailability of a blood PT matrix for transfusion microbiology.

1221 Recipient Outcomes After Simultaneous Pancreas and Kidney Transplant Delineated by Donor eGFR

Abstract Aim This study aimed to assess if the use of kidneys with a decreased eGFR had an adverse effect on patient and graft survival. Method Data on all UK SPKT’s from 2001-2021 were obtained from the NHSBT UK Transplant Registry (n = 2,631). Cases with missing information were removed, leaving a final cohort of 1,819 (69.1%). eGFR was calculated using the CKD-EPI equation. Pancreas Graft (PGS), Kidney Graft (KGS) and patient survival analyses were conducted using Kaplan-Meier plots and Cox-regression models. Results 71% (n = 1,292) of grafts were from donors with an eGFR&amp;gt;90 and 29%(n = 530) were from donors with an eGFR&amp;lt;90. Donors with an eGFR&amp;lt;90 were statistically significantly more likely to be older (p&amp;lt;0.0001), a DBD donor (p = 0.0086**) and have a higher BMI(p&amp;lt;0.0001). Recipients who received a graft from a donor with an eGFR&amp;lt;90 were well matched with those who received a graft from a donor with an eGFR&amp;gt;90. Univariate analysis showed a statistically significant decreased KGS(p = 0.007**) when the donor had an eGFR&amp;lt;90. This trend was not seen when comparing patient or pancreas survival. Conclusions We accept a lower GFR could be indicative of either an AKI or a sign of early chronic kidney disease. In this current data analysis, we have been unable to successfully distinguish between the two however we have shown poorer KGS in those with a lower eGFR (&amp;lt;90). This had no impact on pancreas or patient survival. Further analysis is needed to explain the precise reasons for the lower eGFR’s at the time of organ donation.

SP5.6 A UK-wide audit on peri-operative practices during deceased donor kidney transplantation: Results from a prospective National Transplant ACcess to Theatre (NTACT) Audit

Abstract Background The outcomes of deceased donor kidney transplants are mainly affected by donor and recipient factors. There is little data on standard perioperative practices across the UK and whether variations in perioperative practices could affect the outcomes. This national audit aims to identify current perioperative practices. Methods We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on pre-operative antibiotic use, clinician’s grade, fluid management, central/arterial line insertion, post-operative destination, crossmatch and advanced haemodynamic monitoring use. Data was recorded on RedCap and analysed using descriptive statistics. Results 476 kidney-only transplants were recorded (59 were excluded for incomplete/incorrect data), leaving 417 transplants. In 98.6% of transplants, patients received antibiotics pre-operatively. A wide range of antibiotics were given; the three most used were co-amoxiclav (n=135), ciprofloxacin (n=92) and amikacin (n=62). Most operations were led by a consultant surgeon (91.1% n=380). However, only 60.1% of cases were led by consultant anaesthetists. Central lines were used in 65.5% (273/417) of patients, 41.0% (171/417) used an arterial line, and 25.4% (106/417) had advanced haemodynamic monitoring. A total of 289 cases (69.3%) received goal-directed fluid therapy, of which 74.4% (215/289) used static parameters. Most common post-operative destinations were the transplant ward, 75.3% (n=314), ICU, 9.4% (n=39) and HDU, 10.1% (n=42). Conclusions We identified wide variations in certain perioperative practices. In the future, we would like to assess whether there is any relationship between the variations in practice and postoperative outcomes, such as graft function and mortality.

WTP2.9 Early Deceased Donor Kidney Transplant outcomes: Results from a Prospective National Transplant Access to Theatre (NTACT) Audit

Abstract Background Renal transplantation is increasing, yet there is a paucity of data describing post-operative complications. Therefore, this national audit aims to identify the incidence of early complications that impact patient outcomes. Methods We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on significant checkpoints pre, intra and post-operatively, assessing for 30-day complication and mortality rates. Data was recorded on RedCap and analysed using descriptive statistics. Results 476 kidney-only transplants were recorded, (59 excluded for incomplete/incorrect data). Of 417, 215 were donation after brainstem death (DBD) organs and 202 were donation after circulatory death (DCD) organs. The 30-day mortality was 0.47% (n=2/417). The primary graft function rate was 81%. The 30-day readmission rate was 18%, and median number of readmissions was 1 (IQR: 1-3). Of the readmitted recipients, 92% were readmitted once and 8% were readmitted more than. The 30-day reoperation rate was 12%, and median number of reoperations was 1 (IQR: 1-2), of these, 91% had 1 reoperation and 9% had more than 1 reoperation. Most common indications for reoperations were bleeding 49% (n=25), assessment of graft perfusion 17% (n=9), and wound dehiscence 10% (n=5). We noted a difference in rates of reoperations between DCD and DBD organs, 16% and 9% respectively, however, this was not significant. There was no significant difference in the readmission and mortality rate between DBD and DCD organs. Conclusion The overall early postoperative complication rates and 30-day mortality following deceased donor kidney transplantation are low.

SP5.10 Is there a difference in Survival Outcomes of Dual Kidney Transplants (DKTs) of Allografts Procured from DCD versus DBD Donors in absence of a Dedicated National Pathology Service? A Propensity Score Analysis of UK Transplant Registry. An Epidemiology in Transplant Study Group (ETrSG) Initiative

Abstract Background Dual kidney transplants (DKTs) are generally from supra-marginal or small-for-size kidneys that are implanted to provide optimum total nephron-mass. Glomerulosclerosis Pathology Scoring is used globally to guide whether single or DKT are indicated for transplant. Additionally, there are reported concerns regarding donation after cardiac death (DCD) transplant outcomes’ inferiority to donation after brain death (DBD) transplants but there are no reported survival outcomes of DKT procured from DCD v/s DBD donors. Aim This study aims to research if there is a difference in survival outcomes of DKTs of allografts procured from DCD versus DBD Donors in the UK. Methods In this exploratory analysis, adults who underwent DKT in the UK between Jan 1, 2000, and December 31, 2019, were identified in the NHSBT-Transplant registry data. Post-transplantation graft survival at 1&amp; 3 years was assessed with cox-regression analysis, with propensity scores being used to control for selection bias. Results 51,961 renal transplants were reported to NHSBT during the study period, of whom 525 were DKT. After confounders were controlled for with propensity scores, no significant differences in survival outcomes were found between DCD and DBD transplants. Region of Transplant (OR 1.6, 1.0-2.5; p=0.02), transplant post-Year-2011 (OR 3.0, 1.7-5.2; p&amp;lt;0.00), and non-diabetic donors (OR 2.1, 1.1-3.9, p=0.009) were associated with better graft survival, while DBD transplants were associated with low delayed graft function rates (OR 0.4, 0.27 - 0.59; p&amp;lt;.001). Conclusions Survival outcomes of DKT procured from DCD versus DBD donors are equivalent. These results are admirable as the UK does not have a dedicated National-Pathology-Service to report pre-transplant renal biopsies.

Exploring the increasing need for plasma collection: Perspectives of voluntary nonremunerated donors on payment for plasma in Canada.

The aim of this paper is to understand how voluntary nonremunerated plasma donors in Canada view payment for plasma and the emerging commercial sector. There is a growing global demand for plasma, to produce plasma-derived medical products. Source plasma for these products is collected through voluntary nonremunerated donation, sometimes by a national blood service, or by a commercial plasma collector, remunerating donors. This paper presents findings from qualitative semi-structured interviews with source plasma donors in three new source plasma centres in Canada. Interview data were analysed using abductive analysis, an interpretivist approach that builds on grounded theory. This study indicates that there are a range of perspectives on payment for plasma and the emerging commercial sector, from disinterest in payment, to opposition to payment based on the belief that it could undermine donating to help others, and risk public health and safety. One fifth of participants are open to CBS paying donors if it is necessary to increase national sufficiency of plasma. Almost two thirds of participants are opposed to commercial plasma collection in Canada, claiming that it could undermine Canada's public healthcare system, raising questions about transparency and accountability of the commercial plasma industry. Findings point to important areas for future study, on publicly collected source plasma, the emerging commercial plasma sector, and the role of the donor as a social actor in a complex political system.

Impact of the COVID-19 Pandemic on Blood Donation Patterns: A Systematic Review and Meta-Analysis.

Blood centers, which are arguably the backbone of every hospital, depend on blood donors for a constant and regular supply of blood. Like many other fields, the COVID-19 pandemic severely affected blood donations. In this article, we aim to systematically search the studies done on blood donation during the COVID-19 pandemic period, analyze the pandemic's effect on blood donation, and examine the methodology used to overcome the problem. We performed a systematic review and meta-analysis to investigate the effect of the COVID-19 pandemic on blood donation. Two independent reviewers searched different databases, such as PubMed, ProQuest, Scopus, and Google Scholar. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Joanna Briggs Institute critical appraisal checklist for overall study characteristics. We included a total of 15 studies. There was an overall decrease in blood donation of 25%, with some regions showing a decrease of as much as 71%. However, some regions were able to experience a 2-10% increase in blood donation after taking stringent and early measures to prevent such decreases. The COVID-19 pandemic and consequent lockdown greatly affected blood transfusion services, resulting in a progressive decline in blood donations that threatened the lives of many patients who were fully dependent on blood transfusion. However, by making appropriate and early decisions and taking action, policymakers and the rest of society can prevent such shortages, potentially saving millions of lives.

Impact of the COVID-19 Pandemic on Blood Transfusion Service: A case study from Kolkata, India

Background: The emergence of coronavirus disease (COVID-19) has posed a significant threat to public health all over the world and it has been a difficult challenge for blood banks in India to cope with the situation. In this study, the effect of the COVID-19 pandemic on the blood transfusion service of India has been assessed. Method: The present study is conducted in a stand-alone community blood bank situated in the city of Kolkata, India. A comparative evaluation of supply, demand, and utilization of blood components by analysing pre-pandemic and post-pandemic data from 2017 to 2020 has been presented. Result: As no blood donation camp could be organized due to the country-wide lockdown along with restrictions in mobility and large gatherings during the initial period after the outbreak of the pandemic, a significant reduction of 80.35% in blood collection was observed. The demand for the Packed Red Blood Cell was decreased by 75% due to the postponement of elective surgeries and non-urgent clinical interventions. Blood utilization patterns also changed as 40% of the Packed Red Blood Cell was issued to thalassemia patients during this period. Conclusion: Based on the evaluation of blood bank performance under pre-pandemic and post-pandemic conditions, recommendations such as spreading public awareness, maintaining sufficient safety stock, proper training of blood banking staff, communicating with nearby hospitals, donors, and medical professionals have been identified to be helpful to mitigate the adverse effects of extreme situations such as a pandemic.

Evaluation of interventions to prevent vasovagal reactions among whole blood donors: rationale and design of a large cluster randomised trial

BackgroundVasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors.MethodsSTRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site (“cluster”) has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions is compared to NHSBT’s current practices: (i) 500-ml isotonic drink before donation (vs current 500-ml plain water); (ii) 3-min rest on donation chair after donation (vs current 2 min); (iii) new modified AMT (vs current practice of AMT); and (iv) psychosocial intervention using preparatory materials (vs current practice of nothing). The primary outcome is the number of in-session VVRs with loss of consciousness (i.e. episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e. with and without loss of consciousness), all delayed VVRs (i.e. those occurring after leaving the venue) and any in-session non-VVR adverse events or reactions.DiscussionThe STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency.Trial registrationISRCTN: 10412338. Registration date: October 24, 2019.