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Rodríguez-Espinosa D, Broseta JJ, Rosario A, Cacho J, Tena B, Cuadrado-Payan E, Marrero R, Bayés B, Esforzado N, Musquera M, Diekmann F, Cases A, Basora M. Challenges in perioperative blood transfusions in kidney transplantation and the need for Patient Blood Management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:206-212. [PMID: 37847208 PMCID: PMC11073621 DOI: 10.2450/bloodtransfus.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Anemia is highly prevalent in end-stage chronic kidney disease patients, increasing their risk of receiving blood transfusions during and on the days after a kidney transplant (KTx) surgery. However, there is currently a lack of data that thoroughly describes this phenomenon in this population, the associated risk factors, and how they could benefit from the application of Patient Blood Management (PBM) guidelines. MATERIALS AND METHODS Observational study. All adult patients who received a KTx between January 1st, 2020, and December 31st, 2021, were included and followed up to six months after transplantation. Those who received a multiorgan transplant, whose data was missing in the electronic health records, and who had primary non-function were excluded. We recorded donor and recipient characteristics, cold ischemia time, preoperative hemoglobin concentration, iron status deficiency biomarkers, incidence of delayed graft function and biopsy-proven graft rejections, and graft function at discharge and 6 months after transplantation. RESULTS We found that a high amount (39%) of KTx recipients required at least one blood transfusion during the perioperative period. And that 1) most of these patients had anemia at the time of transplantation (85.4%), 2) iron status upon admission was associated with the transfusion of more blood units (3.9 vs 2.7, p=0.019), 3) surgical reintervention (OR 7.28, 2.35-22.54) and deceased donor donation (OR 1.99, 1.24-3.21) were associated with an increased risk of transfusion, and finally, 4) there was an association between a higher number of blood units transfused and impaired kidney graft function six months after hospital discharge (1.6 vs 1.9, p=0.02). CONCLUSIONS In conclusion, PBM guidelines should be applied to patients on the KTx deceased donor waiting list and especially those scheduled to receive a transplant from a living donor. This could potentially increase the utilization efficiency of blood products and avoid transfusion-related severe adverse effects.
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Affiliation(s)
- Diana Rodríguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - José J. Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anney Rosario
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Judit Cacho
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Beatriz Tena
- Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Elena Cuadrado-Payan
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ramsés Marrero
- Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Beatriu Bayés
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nuria Esforzado
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Aleix Cases
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Anemia group of the Spanish Society of Nephrology, Madrid, Spain
| | - Misericordia Basora
- Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain
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2
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Guzzo I, Atkinson MA. Anemia after kidney transplantation. Pediatr Nephrol 2023; 38:3265-3273. [PMID: 36282330 PMCID: PMC10126210 DOI: 10.1007/s00467-022-05743-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023]
Abstract
Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are multifactorial with iron deficiency being the primary cause of early PTA (within the first 6 months after transplantation) and impaired glomerular filtration rate (GFR) commonly responsible for late PTA (after 6 months). Medications, viral infections, chronic inflammation, and comorbidities also play a role. PTA has relevant long-term consequences and is a potential risk factor for allograft dysfunction, cardiovascular morbidity, and mortality. Thus, an anemia evaluation, approximately 3 months post-transplantation, is recommended in order to start early treatment and improve prognosis. Iron status, vitamin B12, folate, markers of hemolysis, and viral PCR should be checked, and medications, in particular combinations of medications, should be carefully evaluated. PTA treatment may be challenging and should be directed to the underlying causes. Iron supplementation and erythropoietin therapy, not extensively used in KTR, may be indicated. Every effort should be made to avoid blood transfusions in the pre-transplant period to avoid allosensitization. Anemia should be corrected to prepare candidates for kidney transplantation in order to reduce the need for perioperative blood transfusions as well.
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Affiliation(s)
- Isabella Guzzo
- Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Meredith A Atkinson
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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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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4
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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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5
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Acute kidney injury secondary to urinary tract infection in kidney transplant recipients. Sci Rep 2022; 12:10858. [PMID: 35760823 PMCID: PMC9237017 DOI: 10.1038/s41598-022-15035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/16/2022] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) in kidney transplant recipients (KTRs) is a common, yet poorly investigated, complication of urinary tract infections (UTI) and urosepsis. A retrospective comparative analysis was performed, recruiting 101 KTRs with urosepsis, 100 KTRs with UTI, and 100 KTRs without history of UTI or sepsis. The incidences of AKI in the urosepsis and UTI groups were 75.2% and 41%, respectively. The urosepsis group has also presented with a significantly higher prevalence of AKI stage 2 and 3 than the UTI group. The rates of recovery from AKI stages 1, 2 and 3, were 75,6%, 55% and 26.1%, respectively. Factors independently associated with renal recovery from AKI were: AKI severity grade (AKI stage 2 with OR = 0.25 and AKI stage 3 with OR = 0.1), transfusion of red blood cells (RBC) (OR = 0.22), and the use of steroid bolus in the acute phase of treatment (OR = 4). The septic status (urosepsis vs UTI) did not influence the rates of renal recovery from AKI after adjustment for the remaining variables. The dominant cause of RBC transfusions in the whole population was upper GI-bleeding. In multivariable analyses, the occurrence of AKI was also independently associated with a greater decline of eGFR at 1-year post-discharge and with a greater risk of graft loss. In KTRs with both urosepsis and UTI, the occurrence of AKI portends poor transplantation outcomes. The local transfusion policy, modulation of immunosuppression and stress ulcer prophylaxis (which is not routinely administered in KTRs) in the acute setting may be modifiable factors that significantly impact long-term transplantation outcomes.
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6
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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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7
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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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8
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Kouri A, Balani S, Kizilbash S. Anemia in Pediatric Kidney Transplant Recipients-Etiologies and Management. Front Pediatr 2022; 10:929504. [PMID: 35795334 PMCID: PMC9251011 DOI: 10.3389/fped.2022.929504] [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: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
Abstract
Posttransplant anemia (PTA) is a common complication of pediatric kidney transplantation, with a prevalence ranging from 22 to 85%. PTA is categorized as early (within 6 months posttransplant) and late (>6 months posttransplant). Early PTA is typically associated with surgical blood losses and iron deficiency. Late PTA primarily results from graft dysfunction; however, iron deficiency, drug toxicity, and posttransplant inflammation also play a role. PTA is more severe compared with the anemia in glomerular-filtration-rate matched patients with native chronic kidney disease. Treatment of PTA is directed toward the underlying cause. Erythropoiesis stimulating agents (ESA) are effective; however, their use is limited in the transplant setting. Timely diagnosis and treatment of PTA are vital to prevent long-term adverse outcomes in pediatric transplant recipients.
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Affiliation(s)
- Anne Kouri
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Shanthi Balani
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Kizilbash
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
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9
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Exeni AM, Falke GF, Montal S, Rigali MP, Cisnero DR, Berberian L, Marchionatti S, Heredia S, Allegrotti HE, Torres SF, Russo RD, Rozanec J. Pediatric KT in children up to 15 kg: A single-center experience. Pediatr Transplant 2021; 25:e14102. [PMID: 34309990 DOI: 10.1111/petr.14102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND KT is the preferred treatment for ESRD in pediatrics. However, it may be challenging in those weighing ≤15 kg with potential complications that impact on morbidity and graft loss. METHODS This retrospective review reports our experience in KT in children, weighing ≤15 kg, and the strategies to reduce morbidity and mortality. RESULTS All patients were on RRT prior to KT. Patients reached ESRD mainly due to urologic malformations (54.54%). LD was performed in 82% of patients. The recipient's median age was 2.83 years, and median weight 12.280 kg. Male sex was predominant (73%). All patients required transfusions of PRBCs. There was a high requirement for ventilated support in patients post-KT with no relation to weight, amount of resuscitation used intra-operatively or ml/kg of PRBCs. One patient presented with stenosis of the native renal artery. No patients presented DGF, graft thrombosis, or surgical complications. No association was found between cold ischemia and eGFR at 1 year (p = .12). In univariate analysis, eGFR at 1 year is related to AR. eGFR at 3 years is related to the number of UTI. Median follow-up was 1363 days. Patient and graft survival were 100%. CONCLUSIONS KT in children ≤15 kg can be challenging and requires a meticulous perioperative management and surgical expertise. Patient and graft survival are excellent with low rate of complications.
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Affiliation(s)
| | | | - Silvina Montal
- Surgery, Hospital Universitario Austral, Pilar, Argentina
| | | | | | - Leandro Berberian
- Pediatric Surgery and Urology, Hospital Universitario Austral, Pilar, Argentina
| | - Sofia Marchionatti
- Pediatric Surgery and Urology, Hospital Universitario Austral, Pilar, Argentina
| | - Soledad Heredia
- Pediatric Surgery and Urology, Hospital Universitario Austral, Pilar, Argentina
| | | | | | | | - José Rozanec
- Urology, Hospital Universitario Austral, Pilar, Argentina
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10
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Kobayashi H, Konno M, Utsugisawa T, Tanabe K, Kanno H. Preoperative autologous blood donation for kidney transplant and end-stage renal disease patients: A single-center study. Transfus Apher Sci 2021; 60:103149. [PMID: 34148766 DOI: 10.1016/j.transci.2021.103149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
Although preoperative autologous blood donation (PABD) has many advantages, there has been a decrease in the performance due to a decrease in the residual risk of allogeneic blood transfusion. In allogeneic blood transfusion, anti HLA antibodies and donor-specific antibodies mediate antibody-mediated rejection, which results in graft failure. PABD for anemic patients such as those with end-stage renal disease (ESRD) and a kidney transplant is relatively contraindicated. In this study, we aimed to investigate the characteristics of patients who underwent PABD and elucidate the safety and feasibility of PABD. We performed PABD safely in ten ESRD patients and nine kidney transplant patients and retrospectively analyzed medical records of the hospital. All kidney transplant patients avoided allogeneic blood transfusion, but 4 out of 10 ESRD patients had allogeneic blood transfusion, even if their blood donation volume was larger than those of the kidney transplant patients. It depends on the type of operation; cardiovascular surgery was more common in ESRD patients, and orthopedic surgery was more common in kidney transplant patients. There was profuse bleeding in cardiovascular surgery compared to orthopedic surgery because of longer operation time of the former. Completely avoiding allogeneic blood transfusion in major surgery was rather difficult even if PABD was performed. To prevent the formation of anti- HLA antibodies, PABD would be considered for ESRD patients undergoing kidney transplantation and kidney transplant patients that are potential candidates for secondary kidney transplantation.
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Affiliation(s)
- Hirohito Kobayashi
- Division of Transfusion and Cell Therapy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Mayumi Konno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Taiju Utsugisawa
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hitoshi Kanno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
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11
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Massicotte-Azarniouch D, Sood MM, Fergusson DA, Chassé M, Tinmouth A, Knoll GA. Blood Transfusion and Adverse Graft-related Events in Kidney Transplant Patients. Kidney Int Rep 2021; 6:1041-1049. [PMID: 33912754 PMCID: PMC8071620 DOI: 10.1016/j.ekir.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The impact of posttransplant red blood cell transfusion (RBCT) and their potential immunomodulatory effects on kidney transplant recipients are unclear. We examined the risks for adverse graft outcomes associated with post-kidney transplant RBCT. METHODS We conducted a retrospective cohort study of all adult kidney transplant recipients at The Ottawa Hospital from 2002 to 2018. The exposure of interest was receipt of an RBCT after transplant categorized as 1, 2, 3 to 5, and >5 RBC. Outcomes of interest were rejection and death-censored graft loss (DCGL). Cox proportional hazards models were used to calculate hazard ratios (HR) with RBCT as a time-varying, cumulative exposure. RESULTS Among 1258 kidney transplant recipients, 468 (37.2%) received 2373 total RBCTs, 197 (15.7%) had rejection and 114 (9.1%) DCGL. For the receipt of 1, 2, 3 to 5, and >5 RBCT, compared with individuals never transfused, the adjusted HRs (95% confidence interval [CI]) for rejection were 2.47 (1.62-3.77), 1.27 (0.77-2.11), 1.74 (1.00-3.05), and 2.23 (1.13-4.40), respectively; DCGL 2.32 (1.02-5.27), 3.03 (1.62-5.64), 7.50 (4.19-13.43), and 14.63 (8.32-25.72), respectively. Considering a time-lag for an RBCT to be considered an exposure before an outcome to limit reverse causation, RBCT was not associated with rejection; the HRs for DCGL attenuated but remained similar. RBCT was also associated with a negative control outcome, demonstrating possible unmeasured confounding. CONCLUSION RBCT after kidney transplant is not associated with rejection, but may carry an increased risk for DCGL.
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Affiliation(s)
| | - Manish M. Sood
- Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Department of Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alan Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A. Knoll
- Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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12
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Friedersdorff F, Banuelos-Marco B, Koch MT, Lachmann N, Bichmann A, Miller K, Gonzalez R, Müller D, Lingnau A. Immunological Risk Factors in Paediatric Kidney Transplantation. Res Rep Urol 2021; 13:87-95. [PMID: 33654694 PMCID: PMC7914070 DOI: 10.2147/rru.s289853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to identify factors impacting recipient sensitization rates and paediatric renal transplant patient outcomes. Patients and Methods For this purpose, a retrospective analysis of 143 paediatric renal transplants was carried out. This included the evaluation of patient’s and donor’s demographic data, HLA mismatches, immunosuppressive therapy, rejection episodes, panel reactive antibody (PRA) and post-transplant lymphoproliferative disease (PTLD). Results The mean patient age at the point of transplant receival was 11.5 years with a mean follow up time of 9.33±5.05 years. It was noted that graft survival rates for donors over 59 years had the worst outcome. HLA match did not show statistically significant influence on graft outcome. Graft survival for more than one biopsy-proven rejection was also significantly shorter (p=0.008). PRA were found in 28% of the recipient’s post-transplantation and showed association with lower graft survival rates (p<0.001). In the present study, 22.7% (5/22) of the patients with EBV infections presented a PTLD. Conclusion In conclusion, good graft survival with reduced sensitization for future transplantations and minimize the risk of PTLD, can be ensured through a balance between donor age, HLA match and condition of the recipient should be sought. Furthermore, paediatric patients should preferably receive organs from donors between the age of 10 and 59. EBV infection could be a relevant factor for developing PTLD.
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Affiliation(s)
- Frank Friedersdorff
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Clinic of Urology and Paediatric Urology, Berlin, Germany
| | - Beatriz Banuelos-Marco
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Clinic of Urology and Paediatric Urology, Berlin, Germany
| | - Marie-Therese Koch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Department of Paediatric Gastroenterology, Nephrology and Metabolic Disorders, Berlin, Germany
| | - Nils Lachmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Institute of Transfusion Medicine, Berlin, Germany
| | - Anna Bichmann
- Charité - Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Kurt Miller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Clinic of Urology and Paediatric Urology, Berlin, Germany
| | - Ricardo Gonzalez
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Clinic of Urology and Paediatric Urology, Berlin, Germany
| | - Dominik Müller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Department of Paediatric Gastroenterology, Nephrology and Metabolic Disorders, Berlin, Germany
| | - Anja Lingnau
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Clinic of Urology and Paediatric Urology, Berlin, Germany
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13
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Daloul R, Braga JR, Diez A, Logan A, Pesavento T. Early Posttransplant Blood Transfusion and Risk for Worse Graft Outcomes. Kidney Int Rep 2021; 6:986-994. [PMID: 33912748 PMCID: PMC8071616 DOI: 10.1016/j.ekir.2020.12.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Blood transfusion is a risk factor for allosensitization. Nevertheless, blood transfusion posttransplant remains a common practice. We evaluated the effect of posttransplant blood transfusion on graft outcomes. Methods We 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). Results 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). Conclusion 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.
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Affiliation(s)
- Reem Daloul
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Juarez R Braga
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Diez
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | - April Logan
- The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Todd Pesavento
- The Ohio State University Medical Center, Columbus, Ohio, USA
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14
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Hassan S, Regan F, Brown C, Harmer A, Anderson N, Beckwith H, Roufosse CA, Santos-Nunez E, Brookes P, Taube D, Willicombe M. Shared alloimmune responses against blood and transplant donors result in adverse clinical outcomes following blood transfusion post-renal transplantation. Am J Transplant 2019; 19:1720-1729. [PMID: 30582278 DOI: 10.1111/ajt.15233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023]
Abstract
De novo HLA donor-specific antibodies (DSA) following transplantation are associated with alloimmune injury and allograft failure. Blood transfusions are allogeneic, and when given posttransplant (PTBT) they may independently increase the risk of HLA antibody development. This study aims to analyze the development of HLA transfusion-specific antibodies (TSA) to blood donors of transfusions given posttransplant and examine the impact on clinical outcomes. A total of 244 blood donors of transfusions received by 86 transplant patients (46 who developed a DSA post transfusion and 40 who remained DSA negative) were HLA typed. De novo TSA developed against 150/244 (61.5%) blood donors. In 70/150 (46.7%) cases the TSA was of shared HLA antibody specificity with a DSA response in the recipient (DSA+ = TSA+). This occurred when there was a greater overall HLA match between the blood and transplant donor. DSA+ = TSA+ patients had increased risk of allograft failure (P = .0025) and AMR (P = .02) compared with the DSA+ ≠ TSA+ patients. To conclude, PTBT may elicit de novo HLA antibodies. Enhanced HLA matching between the blood and transplant donor is more likely to result in a DSA and TSA of shared antibody specificities. Transfusion avoidance or the use of HLA matched or selected blood may reduce this risk and improve outcomes.
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Affiliation(s)
- Sevda Hassan
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Fiona Regan
- Haematology, NHS Blood and Transplant, London, UK.,Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Colin Brown
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, London, UK
| | - Andrea Harmer
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, London, UK
| | - Nicky Anderson
- Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Hannah Beckwith
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Candice A Roufosse
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, UK
| | - Eva Santos-Nunez
- Histocompatibility and Immunogenetics, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Brookes
- Histocompatibility and Immunogenetics, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - David Taube
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Michelle Willicombe
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, UK
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15
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Kristof K, Büttner B, Grimm A, Mewes C, Schmack B, Popov AF, Ghadimi M, Beissbarth T, Hinz J, Bergmann I, Mansur A. Anaemia requiring red blood cell transfusion is associated with unfavourable 90-day survival in surgical patients with sepsis. BMC Res Notes 2018; 11:879. [PMID: 30537993 PMCID: PMC6290543 DOI: 10.1186/s13104-018-3988-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/05/2018] [Indexed: 12/26/2022] Open
Abstract
Objective The mortality associated with sepsis remains unacceptably high, despite modern high-quality intensive care. Based on the results from previous studies, anaemia and its management in patients with sepsis appear to impact outcomes; however, the transfusion policy is still being debated, and the ideal approach may be extremely specific to the individual. This study aimed to investigate the long-term impact of anaemia requiring red blood cell (RBC) transfusion on mortality and disease severity in patients with sepsis. We studied a general surgical intensive care unit (ICU) population, excluding cardiac surgery patients. 435 patients were enrolled in this observational study between 2012 and 2016. Results Patients who received RBC transfusion between 28 days before and 28 days after the development of sepsis (n = 302) exhibited a significantly higher 90-day mortality rate (34.1% vs 19.6%; P = 0.004, Kaplan–Meier analysis). This association remained significant after adjusting for confounders in the multivariate Cox regression analysis (hazard ratio 1.68; 95% confidence interval 1.03–2.73; P = 0.035). Patients who received transfusions also showed significantly higher morbidity scores, such as SOFA scores, and ICU lengths of stay compared to patients without transfusions (n = 133). Our results indicate that anaemia and RBC transfusion are associated with unfavourable outcomes in patients with sepsis. Electronic supplementary material The online version of this article (10.1186/s13104-018-3988-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katalin Kristof
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Benedikt Büttner
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Anna Grimm
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Caspar Mewes
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University Hospital, Ruprecht Karls University, Heidelberg, Germany
| | - Aron Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Goethe University, Frankfurt, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Georg August University, Goettingen, Germany
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center, Georg August University, Goettingen, Germany
| | - José Hinz
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Ingo Bergmann
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany.
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16
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Richards KM, Spicer RA, Craig E, Kennedy SE. Prevalence and predictors of blood transfusion after pediatric kidney transplantation. Pediatr Nephrol 2018; 33:2177-2184. [PMID: 30006835 DOI: 10.1007/s00467-018-4017-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Blood transfusion after kidney transplant carries a risk of sensitization to the graft as well as blood borne infections. The aim of this study was to describe the prevalence of blood transfusions in pediatric recipients of kidney transplants and to determine the factors associated with transfusions during the perioperative period. Additionally, to describe the changes in hemoglobin levels during the first 12 months following transplant. METHOD A retrospective, single center analysis using data collected prospectively between 2010 and 2017. Red blood cell transfusion within the first week after transplant and anemia at 3 months were used as outcomes. Multivariate analysis was performed on significant variates with results described according to odds ratio (OR) and interquartile range (IQR). RESULTS Transfusions were given after 21 of 42 (50%) transplants in recipients aged between 1 and 17 years (median 14 years). Age, height, weight, and pre-transplant hemoglobin predicted transfusion in univariate analyses. Regression analysis identified pre-transplant hemoglobin as an independent factor (OR 0.85, IQR 0.73-0.98; p = 0.02). Anemia was present at 3 months after 15 (36%) transplants. Anemia at 3 months was associated with older and larger recipients, lower pre-transplant hemoglobin, and lower estimated glomerular filtration rate (eGFR) on univariate analysis. Logistic regression analysis identified eGFR at 3 months as the only independent predictor of anemia at 3 months (OR 0.93, IQR 0.87-0.99; p = 0.04). CONCLUSIONS Transfusions are prevalent in the perioperative period after pediatric kidney transplantation. Lower pre-transplant hemoglobin increases the risk of transfusion. Graft function predicts hemoglobin levels at 3 months.
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Affiliation(s)
- Katherine M Richards
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Sean E Kennedy
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia. .,Nephrology, Sydney Children's Hospital, Randwick, Australia.
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17
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Verghese PS, Rheault MN, Jackson S, Matas AJ, Chinnakotla S, Chavers B. The effect of peri-transplant plasmapheresis in the prevention of recurrent FSGS. Pediatr Transplant 2018; 22:e13154. [PMID: 29388290 DOI: 10.1111/petr.13154] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
Many pediatric centers utilize a variety of protocols including preemptive plasmapheresis to prevent the recurrence of FSGS post-transplant. But the effectiveness of this expensive, time-consuming process of plasmapheresis in the prevention of FSGS recurrence is still unclear. We retrospectively reviewed all pediatric cases of FSGS in our center that received a kidney transplant and compared the transplant and patient outcomes of those transplanted after 2006 who received pretransplant plasmapheresis to those prior to 2006 who did not. Of the 57 children with FSGS, 31 and 26 were transplanted before and after 2006, respectively. The cohorts differed significantly in keeping with the center immunosuppression protocol changes, and prior to 2006, the recipients were significantly younger. All children with FSGS transplanted after 2006 underwent three and one sessions of 1.0 plasma volume/exchange plasmapheresis with fresh frozen plasma replacement prior to the transplant in living and deceased donors, respectively, in addition to five sessions of every other day post-transplant pheresis. The incidence (27% vs 26%, P = 1.0) and time to recurrence of FSGS in the kidney allograft (P = .22) were not significantly different in patients that did and did not undergo prophylactic plasmapheresis. We need to re-evaluate the role of preemptive plasmapheresis in the prevention of FSGS recurrence in a prospective multicenter study.
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Affiliation(s)
- P S Verghese
- Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - M N Rheault
- Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - S Jackson
- Informatics Services for Research and Reporting, M Health, Minneapolis, MN, USA
| | - A J Matas
- Department of Surgery, Division of Transplant Surgery, University of Minnesota, Minneapolis, MN, USA
| | - S Chinnakotla
- Department of Surgery, Division of Transplant Surgery, University of Minnesota, Minneapolis, MN, USA
| | - B Chavers
- Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
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18
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Kloesel B, Verghese PS, Belani K. Issues in Pediatric Kidney Transplantation. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0269-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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