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Tsapepas D, Ramakrishnan A, Salerno DM, Husain SA, King K, Mohan S. Impact of peri-operative red blood cell transfusions for treatment of anemia on acute rejection in renal transplant recipients. Transfus Apher Sci 2024; 63:103896. [PMID: 38365525 DOI: 10.1016/j.transci.2024.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Anemia occurs before and after kidney transplantation. Determining the impact of perioperative transfusion on post-transplant outcomes can help determine best management of anemia. PROJECT AIM The current study aims to describe clinical outcomes associated with packed red blood cell transfusions in the peri-operative management of anemia after transplantation. DESIGN This was a single-center, retrospective study of adult kidney recipients with anemia at the time of transplantation. 1271 patients were stratified by donor-type due to the potential variability in underlying recipient and transplant characteristics; living donor (n = 698, 62%) or deceased donor (n = 573, 38%). RESULTS Living donor recipients that received blood during the index hospitalization were more likely to experience rejection within 30 days (18% vs. 10%, p = 0.008) and 1 year of transplant (32% vs. 16%, p = 0.038). In multivariate analysis, receiving both blood and darbepoetin (HR: 1.89 [1.20,3.00], p = 0.006), age at transplant (HR: 0.98 [0.97, 0.99], p = 0.02), number of HLA mismatches (HR: 1.17 [1.05,1.30], p = 0.003), and whether the case was a repeat transplant (HR: 2.77 [1.93,3.97], p < 0.01) were significantly associated with hazard of rejection. For deceased donor recipients, there were no differences in acute rejection, graft failure or mortality at 30 days or 1 year. When analyzing hazard of rejection in a multivariate model, treatment received was not found to be significantly associated with rejection. CONCLUSION Our findings suggest there may be a role for more aggressive pre-transplant treatment of anemia for those patients undergoing living donor transplants.
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Affiliation(s)
- Demetra Tsapepas
- Department of Transplant Analytics, New York-Presbyterian Hospital, New York, NY, USA; Department of Transplant Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Adarsh Ramakrishnan
- Department of Transplant Analytics, New York-Presbyterian Hospital, New York, NY, USA.
| | - David M Salerno
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY, USA
| | - Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Kristen King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kang ZY, Liu C, Liu W, Li D. Association between blood transfusion after kidney transplantation and risk for the development of de novo HLA donor-specific antibodies and poor clinical outcomes: A single-center retrospective study. Transpl Immunol 2023; 81:101930. [PMID: 37730183 DOI: 10.1016/j.trim.2023.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Blood transfusion after kidney transplantation may increase the risk of sensitization and development of de novo human leukocyte antigen (HLA) donor-specific antibodies (DSAs). This study aimed to evaluate whether blood transfusion during the first year after kidney transplantation influences the development of de novo DSAs and clinical outcomes of kidney transplantation recipients. METHODS This retrospective cohort study included nonsensitized first-time kidney transplantation recipients at Tianjin First Central Hospital from 2010 to 2022. The incidence of de novo DSA development and clinical outcomes between the groups were compared. Luminex single antigen beads were used to monitor DSAs. RESULTS Of the 538 non-HLA-sensitized kidney transplantation recipients included in the study, 164 patients who received at least one unit of leukoreduced red blood cell transfusion within the first year (the transfused group), whereas the remaining 374 patients received no blood transfusion (the non-transfused group). Our analysis showed that there was a significant difference in the development of de novo DSAs and de novo anti-class I HLA-Ab between the two groups. Indeed, the transfused recipients had a higher serum creatinine and lower estimated glomerular filtration rate (eGFR) at 1-, 6-, and 12-month (all p > 0.05) after transplantation. Futhermore, a higher incidence of CMV infection, antibody-mediated rejection (AMR), hyper acute rejection (HAR), and delayed graft function (DGF) was identified in the transfused group (all p < 0.05). The graft survival was lower in the transfused group compared with patients in the non-transfused group (P = 0.002). Blood transfusion post-transplantation was a risk factor for de novo DSAs development but not an independent predictive factor for AMR and graft loss (odds ratio = 2.064 [1.243-3.429], p = 0.005). CONCLUSIONS Our study showed that blood transfusion after transplantation is associated with the occurrence of de novo DSAs increasing an immunological risk for poor clinical outcomes for kidney transplantation recipients.
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Affiliation(s)
- Zhong-Yu Kang
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Chun Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Wei Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Daihong Li
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China.
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3
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Hassan S, Gleeson S, Thomson T, Spensley KJ, Dor F, Brown C, Regan F, Pengel LHM, Willicombe M, Roberts DJ. Clinical impact of early post-transplant red cell transfusions in kidney transplantation: a systematic review and meta-analysis. FRONTIERS IN TRANSPLANTATION 2023; 2:1215130. [PMID: 38993906 PMCID: PMC11235259 DOI: 10.3389/frtra.2023.1215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2024]
Abstract
Introduction Red blood cell transfusions (RBCT) represent a potentially modifiable risk factor for HLA sensitisation and adverse outcomes post transplantation. Evidence of the clinical impact of post-transplant RBCT has been infrequently reported. Herein, we performed a systematic review of available literature to assess the prevalence of RBCT post kidney transplant, and the effect of transfusion on transplant outcomes. Methods We included studies from 2000 to July 2022, published on Medline, Embase and the Transplant Library. Results Ten studies were analysed which included a total of 32,817 kidney transplant recipients, with a median transfusion prevalence of 40% (range 18-64%). There was significant heterogeneity between studies in terms of patient and allograft characteristics, immunological risk, and immunosuppression protocols. Analysis of unadjusted outcomes showed that post-transplant RBCTs are associated with inferior patient survival, allograft loss, rejection and donor specific antibodies. Adjusted outcomes were described where available, and supported the adverse associations seen in the unadjusted models in many studies. Discussion This review demonstrates that RBCT post-transplant are common and maybe associated with inferior outcomes, highlighting the urgent need for high quality prospective evidence of the effect of RBCTs on transplant outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier, CRD42022348763767.
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Affiliation(s)
- Sevda Hassan
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Sarah Gleeson
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Tina Thomson
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Katrina J Spensley
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Frank Dor
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Colin Brown
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, London, United Kingdom
| | - Fiona Regan
- Blood Transfusion, NHS Blood and Transplant, London, United Kingdom
| | - Liset H M Pengel
- Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Michelle Willicombe
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - David J Roberts
- BRC Haematology Theme, Radcliffe Department of Medicine, and Department of Haematology Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
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Bukhari MA, Alhomayani FK, Al Eid HS, Al-Malki NK, Alotaibi ME, Hussein MA, Habibullah ZN. Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study. World J Transplant 2023; 13:157-168. [PMID: 37388388 PMCID: PMC10303415 DOI: 10.5500/wjt.v13.i4.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Blood transfusion is common during the peri-transplantation period. The incidence of immunological reactions to blood transfusion after kidney transplantation and their consequences on graft outcomes have not been extensively studied.
AIM To examine the risk of graft rejection and loss in patients who received blood transfusion in the immediate peri-transplantation period.
METHODS We conducted a single-center retrospective cohort study of 105 kidney recipients, among them 54 patients received leukodepleted blood transfusion at our center between January 2017 and March 2020.
RESULTS This study included 105 kidney recipients, of which 80% kidneys were from living-related donors, 14% from living-unrelated donors, and 6% from deceased donors. Living-related donors were mostly first-degree relatives (74.5%), while the rest were second-degree relatives. The patients were divided into transfusion (n = 54) and non-transfusion (n = 51) groups. The average hemoglobin level at which blood transfusion was commenced was 7.4 ± 0.9 mg/dL. There were no differences between the groups in terms of rejection rates, graft loss, or death. During the study period, there was no significant difference in creatinine level progression between the two groups. Delayed graft function was higher in the transfusion group; however, this finding was not statistically significant. A high number of transfused packed red blood cells was significantly associated with increased creatinine levels at the end of the study.
CONCLUSION Leukodepleted blood transfusion was not associated with a higher risk of rejection, graft loss, or death in kidney transplant recipients.
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Affiliation(s)
- Muhammad A Bukhari
- Multi-organ Transplantation Center, King Abdullah Medical City, Makkah 29123, Saudi Arabia
| | - Faisal K Alhomayani
- Department of Internal Medicine, College of Medicine, Taif University, Taif 23611, Saudi Arabia
| | - Hala S Al Eid
- Department of Pharmacy, Alhada Armed Forces Hospital, Taif 29123, Saudi Arabia
| | - Najla K Al-Malki
- Department of Nephrology and Transplantation, Alhada Armed Forces Hospital, Taif 29123, Saudi Arabia
| | - Mutlaq Eidah Alotaibi
- Department of Nephrology and Transplantation, Alhada Armed Forces Hospital, Taif 29123, Saudi Arabia
| | - Mohamed A Hussein
- Department of Nephrology and Transplantation, Alhada Armed Forces Hospital, Taif 29123, Saudi Arabia
| | - Zainab N Habibullah
- Multi-organ Transplantation Center, King Abdullah Medical City, Makkah 29123, Saudi Arabia
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5
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Kang ZY, Ma S, Liu W, Liu C. Effect of blood transfusion post kidney transplantation on de novo human leukocytes antigen donor-specific antibody development and clinical outcomes in kidney transplant recipients: A systematic review and meta-analysis. Transpl Immunol 2023; 78:101801. [PMID: 36841513 DOI: 10.1016/j.trim.2023.101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/10/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
The relationship between blood transfusion following kidney transplantation (KT) and the development of de novo donor-specific antibodies (dnDSA) is controversial. This was investigated by conducting a meta-analysis of studies on patients who underwent KT with or without blood transfusion, and by evaluating the effect of post-KT blood transfusion on clinical outcomes of kidney transplant recipients. Relevant studies in the PubMed, EMBASE, and Cochrane Library databases were identified from inception to July 1, 2022. Two reviewers independently extracted data from the selected articles and estimated study quality. A fixed effects or random effects model was used to pool data according to the heterogeneity among studies. Data included in the meta-analysis were derived from 11 studies with a total of 19,543 patients including 6191 with and 13,352 without blood transfusion post-KT. We assessed the pooled associations between blood transfusion and occurrence of dnDSA and clinical outcomes of transplant recipients. Blood transfusion was strongly correlated with the development of dnDSA (relative risk [RR] = 1.40, 95% confidence interval [CI]: 1.17-1.67; P < 0.05). Patients with blood transfusion had a higher risk of developing anti-human leukocyte antigen (HLA) class I dnDSA than non-transfused patients (RR = 1.75, 95% CI: 1.14-2.69; P < 0.05) as well as significantly higher rates of antibody-mediated rejection (AMR) (RR = 1.41, 95% CI: 1.21-2.35; P < 0.05) and graft loss (RR = 1.75, 95% CI: 1.30-2.35; P < 0.05). There were no statistically significant differences between the two groups in the development of anti-HLA antibodies, anti-HLA class II dnDSA, and anti-HLA class I and II dnDSA; delayed graft function; T cell-mediated rejection; acute rejection; borderline rejection; or patient death. Our results suggest that blood transfusion was associated with dnDSA development in KT recipients. The findings of this systematic review also suggest that post-KT blood transfusion recipients have a higher risk of AMR, and graft loss compared with non-transfused patients. Evidence from this meta-analysis indicates that the use of blood transfusion post-KT is associated with a significantly higher risk of immunological sensitization. More and higher quality results from large randomized controlled trials are still needed to inform clinical practice.
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Affiliation(s)
- Zhong-Yu Kang
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, Nankai, China
| | - Shuangshuang Ma
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, Nankai, China
| | - Wei Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, Nankai, China
| | - Chun Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, Nankai, China.
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6
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Lim WH, Ho J, Kosmoliaptsis V, Sapir-Pichhadze R. Editorial: Future challenges and directions in determining allo-immunity in kidney transplantation. Front Immunol 2022; 13:1013711. [PMID: 36119031 PMCID: PMC9473680 DOI: 10.3389/fimmu.2022.1013711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- *Correspondence: Wai H. Lim,
| | - Julie Ho
- Department of Internal Medicine University of Manitoba, Winnipeg, MB, Canada
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Adult Kidney Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Blood and Transplant Research Unit in Organ Donation and Transplantation, National Institute for Health Research, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
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7
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Gaiffe E, Vernerey D, Bardiaux L, Leroux F, Meurisse A, Bamoulid J, Courivaud C, Saas P, Tiberghien P, Ducloux D. Early Post-Transplant Red Blood Cell Transfusion Is Associated With an Increased Risk of Transplant Failure: A Nationwide French Study. Front Immunol 2022; 13:854850. [PMID: 35711440 PMCID: PMC9197232 DOI: 10.3389/fimmu.2022.854850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Red blood cell (RBC) transfusions are frequently required in the early period after kidney transplantation. However, the consequences of RBC transfusions on long-term outcomes are largely unrecognized. Methods We conducted a nationwide French cohort study involving all 31 French kidney transplant centers. Patients having received a first kidney transplant between January 1, 2002 and December 31, 2008 were identified through the national registry of the French BioMedecine Agency (Agence de BioMédecine). Number and date of RBC transfusions were collected from the national database of the French transfusion public service. The primary endpoint was transplant failure defined as graft loss or death with a functional graft. Results Among 12,559 patients included during the study period, 3,483 (28%) were transfused during the first 14 days post-transplant. Median follow-up was 7.6 (7.5-7.8) years. Multivariable analysis determined that post-transplant RBC transfusion was associated with an increased risk in transplant failure (HR 1.650, 95%CI [1.538;1.771] p<0.0001). Both sensitivity and propension score analyses confirmed the previous result. Conclusions Early red blood cell transfusion after kidney transplantation is associated with increased transplant failure.
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Affiliation(s)
- Emilie Gaiffe
- Besançon University Hospital, Fédération Hospitalo-Universitaire Integrated Center for REsearch in inflammatory diseASes (FHU INCREASE), Besançon, France.,Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Dewi Vernerey
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Methodology and Quality of Life in Oncology Unit, Centre Hospitalier Universitaire (CHU) Besançon, Besançon, France
| | | | - Franck Leroux
- Institut National de la santé et de la recherche médicale Centre d'Investigation Clinique (INSERM CIC)-1431, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Aurelia Meurisse
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Methodology and Quality of Life in Oncology Unit, Centre Hospitalier Universitaire (CHU) Besançon, Besançon, France
| | - Jamal Bamoulid
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Cécile Courivaud
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Philippe Saas
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Institut National de la santé et de la recherche médicale Centre d'Investigation Clinique (INSERM CIC)-1431, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Pierre Tiberghien
- Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Etablissement Français du Sang, La Plaine St Denis, France
| | - Didier Ducloux
- Besançon University Hospital, Fédération Hospitalo-Universitaire Integrated Center for REsearch in inflammatory diseASes (FHU INCREASE), Besançon, France.,Univ. Bourgogne Franche-Comté, Institut National De La Santé et de la Recherche Médicale (INSERM), Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte De Recherche 1098 (UMR1098), RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
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8
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Khedjat K, Lenain R, Hamroun A, Baes D, Top I, Labalette M, Lopez B, Van Triempont M, Provôt F, Frimat M, Gibier JB, Hazzan M, Maanaoui M. Post-Transplantation Early Blood Transfusion and Kidney Allograft Outcomes: A Single-Center Observational Study. Transpl Int 2022; 35:10279. [PMID: 35368637 PMCID: PMC8971186 DOI: 10.3389/ti.2022.10279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
The association between blood transfusion and the occurrence of de novo HLA donor specific antibodies (DSA) after kidney transplantation remains controversial. In this single-center observational study, we examined the association between early blood transfusion, i.e. before 1-month post-transplantation, and the risk of DSA occurrence, using Luminex based-methods. In total, 1,424 patients with a minimum of 1-month follow-up were evaluated between January 2007 and December 2018. During a median time of follow-up of 4.52 years, we observed 258 recipients who had at least one blood transfusion during the first month post-transplantation. At baseline, recipients in the transfused group were significant older, more sensitized against HLA class I and class II antibodies and had a higher 1-month serum creatinine. Cox proportional hazards regression analyses did not show any significant association between blood transfusion and the risk of de novo DSA occurrence (1.35 [0.86–2.11], p = 0.19), the risk of rejection (HR = 1.33 [0.94–1.89], p = 0.11), or the risk of graft loss (HR = 1.04 [0.73–1.50], p = 0.82). These data suggest then that blood transfusion may not be limited when required in the early phase of transplantation, and may not impact long-term outcomes.
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Affiliation(s)
| | - Rémi Lenain
- Department of Nephrology, CHU Lille, Lille, France.,INSERM UMR 1246 -SPHERE, Nantes University, Tours University, Nantes, France
| | - Aghilès Hamroun
- Department of Nephrology, CHU Lille, Lille, France.,Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, Inserm, Paris-Saclay University, Versailles Saint Quentin University, Villejuif, France
| | | | - Isabelle Top
- CHU Lille, Institut d'Immunologie, Bd du Professeur Jules Leclercq, Lille, France.,Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Myriam Labalette
- CHU Lille, Institut d'Immunologie, Bd du Professeur Jules Leclercq, Lille, France.,Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Benjamin Lopez
- Laboratoire de Biologie Médicale, CH Dunkerque, Dunkerque, France
| | | | | | - Marie Frimat
- Department of Nephrology, CHU Lille, Lille, France
| | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis", Lille, France
| | - Marc Hazzan
- Department of Nephrology, CHU Lille, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1190-EGID, Lille, France
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9
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Sullivan HC, Gebel HM. Hurts So Good: Uncovering the Relationship Between Blood Transfusions and Allograft Outcome. Kidney Int Rep 2021; 6:875-877. [PMID: 33939774 PMCID: PMC8071641 DOI: 10.1016/j.ekir.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harold C. Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Howard M. Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
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