Risk Factors of Antibody-Mediated Rejection and Predictors of Outcome in Kidney Transplant Recipients

Impact of early blood transfusion after kidney transplantation on the clinical outcomes and allograft survival

INTRODUCTION

Anemia in chronic kidney disease is of great concern regarding blood transfusions and the possibility of allosensitization for future kidney transplants and the occurrence of rejection and allograft loss in the post-transplant period. The aim of this study was to evaluate the effect of early blood transfusion on the occurrence of rejections, allograft function and survival in the first year after transplantation.

MATERIAL AND METHODS

This retrospective study was carried out with 445 patients submitted to kidney transplant allocated to two groups. The first group received early blood transfusions after transplant (n = 125, 28.09%), and the second group did not receive blood transfusions (n = 320, 71.91%). The patient outcomes were evaluated during a 1-year follow-up.

RESULTS

14 patients given blood transfusion (11.2%) lost their allograft in the first year in comparison with 8 (2.5%) without transfusion (p < 0.001). There were 9 deaths in each group, which corresponded to 7.2% of the patients who received blood transfusions and 2.81% of those who did not (p < 0.035). Patient hospitalization lasted 15 days in transfusion group and 8.5 days in non-transfusion group (p < 0.001). Creatinine levels were higher in the patients who received blood transfusion than in those without transfusion in the first and third months after transplantation (p = 0.012 and 0.038, respectively). During the first year, the patients who received blood products experienced more antibody-mediated rejection (ABMR) (13.60%) than patients who did not (4.38%) (p < 0.001). Those who received blood transfusions also developed de novo DSA in higher proportion than those without transfusion against both class I and class II HLA (p < 0.001).

CONCLUSION

This study showed that blood transfusions in the first month after transplantation had a negative impact on kidney function, graft survival, and contributed to the development of de novo DSA, an increased risk of ABMR and infections.

Immune checkpoint inhibitors increase the risk of kidney transplant rejection: a real-world pharmacovigilance study

BACKGROUND

Kidney transplant recipients with cancer are at higher risk of kidney transplant rejection (KTR), and the safety of immune checkpoint inhibitors (ICIs) is unclear. The present study investigates the relationship between ICIs and KTR using data from the Food and Drug Administration Adverse Event Reporting System (FAERS).

RESEARCH DESIGN AND METHODS

Case reports of KTR inducted by ICIs in FAERS from January 1, 2011, to June 30, 2021, were collected, and a disproportionate analysis was performed to assess the correlation between ICIs and KTR.

RESULTS

A total of 99 cases of ICI-related KTR were reported in the FAERS database. Most of them were male patients (n=63, 84.0%), and more than half of patients suffered from malignant melanoma (n=46, 52.9%). The median onset time after the medication was 22 days, the withdrawal rates of ICIs were 78.0%, and the overall death rate was 29.3%. In general, there was a significant relevance between ICIs and KTR (ROR=3.92[3.21-4.79] IC025=1.56), of which PD-1 was the most prominent (n=81 ROR=5.26[4.22-6.57] IC025=1.86).

CONCLUSIONS

ICIs may increase the risk of KTR in organ transplant recipients with cancer.