Early blood transfusion in kidney transplant not tied to graft rejection: Study
Pregnancy, blood product transfusion, and previous organ transplantation have been associated with the development of HLA sensitization. Kidney transplant candidates are at particularly increased risk for sensitization from blood transfusion because of the high prevalence of anemia associated with kidney disease.8 Exposure to HLA antigens on the surface of red blood cells and leukocytes has been associated with not only the development of new anti-HLA antibodies but also an increase in the breadth of the preexisting antibody profile, measured by calculated panel reactive antibody. The use of leukocyte-reduced blood products does not seem to eliminate such a risk. International guidelines for the management of anemia in patients with chronic kidney disease have been established to standardize anemia treatment and promote a reduction in blood transfusion. These guidelines explicitly call for avoiding the administration of blood products in patients eligible for organ transplantation.
In a recent development , researchers have reported that early transfusion of blood products in kidney transplant recipients receiving induction with lymphocyte depletion was not associated with an increased hazard of experiencing acute rejection, death from any cause, or graft loss. The study findings have been put forth in Kidney International Reports.
Blood transfusion is a risk factor for allosensitization. Nevertheless, blood transfusion post transplant remains a common practice. The team evaluated the effect of post transplant blood transfusion on graft outcomes.
As for the study design, researchers included nonsensitized, first-time, kidney-alone recipients transplanted between 1 July 2015 and 31 December 2017. Patients were grouped based on receiving blood transfusion in the first 30 days posttransplant.
The primary end point was a composite outcome of biopsy-proven acute rejection, death of any cause, or graft failure in the first year posttransplant. Secondary outcomes included the individual components of the primary outcome and the cumulative incidence of de novo donor-specific antibodies (DSAs).
Data analysis revealed the following facts.
- Two hundred seventy-three patients were included.
- One hundred twenty-seven (47%) received blood transfusion. Patients in the transfusion group were more likely to be older, have had a deceased donor, and have received induction with basiliximab.
- There was no difference between groups in the composite primary outcome (adjusted hazard ratio = [HR] 1.34; 95% confidence interval [CI], 0.83–2.17; P = 0.23).
- The cumulative incidence of de novo DSAs during the first year posttransplant was similar between groups (12.8% transfusion vs. 10.9% no transfusion, P = 0.48).
For the full article follow the link: Daloul R, Braga JR, Diez A, Logan A, Pesavento T. Early post-transplant blood transfusion and risk for worse graft outcomes. Published January 21, 2021. Kidney Int Rep. doi:10.1016/j.ekir.2020.12.03
Primary source: Kidney International Reports