Use of oldest PRBC for transfusion after kidney transplant associated with better outcomes: JAMA

In the cohort study involving 12 559 kidney transplant recipients, longer RBC storage led to longer transplant survival among patients receiving early posttransplant transfusion.

Patients undergoing kidney transplants frequently require blood transfusion in the early period post-transplantation. There is no clarity on long-term outcomes associated with red blood cell transfusion. Therefore, investigating the association between RBC transfusion (RBCT) characteristics and transplant outcomes may be relevant.

Emilie Gaiffe and colleagues from France aimed to study the association between RBC storage duration and transplant outcomes by conducting a nationwide retrospective cohort study based on linking data between 2 prospective French nationwide registries. From the CRISTAL registry and national database, the research team extracted clinical transplant parameters, RBCT characteristics, and outcomes.

The study included 12 559 patients who had received a first kidney transplant in France between 2002 and 2008. Follow-up of the patients was done from transplant to graft loss, death with a functional graft, or data retrieval in June 2016.

Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022.

Clinical outcomes were analyzed considering transfusion characteristics of transplant recipients who underwent early RBCT. Transplant failure defined as graft loss or death with a functional graft was evaluated using Cox proportional hazards regression models.

The study led to the following findings:

• Among 12 559 patients who underwent kidney transplants, 3483 received an RBCT during the first 14 days posttransplant. The median age of patients was 53.0 years, and 55.4% were male. The median follow-up was 7.8 years.
• In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in the risk of transplant failure (hazard ratio, 0.99).
• Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days.

"The study findings show an association between longer RBC storage duration and improved graft survival," the researchers wrote. "These results may support the use of the oldest RBC available for transfusion following kidney transplants."

Reference:

Gaiffe E, Vernerey D, Bardiaux L, et al. Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion. JAMA Netw Open. 2023;6(9):e2332821. doi:10.1001/jamanetworkopen.2023.32821