Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management
BackgroundPatient Blood Management (PBM), endorsed by the World Health Organisation is an evidence-based, multi-disciplinary approach to minimise inappropriate blood product transfusions. Kidney transplantation presents a particular challenge to PBM, as comprehensive evidence of the risk of transfus...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Nephrology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneph.2023.1236520/full |
| _version_ | 1797773504966295552 |
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| author | Sevda Hassan Sevda Hassan Lisa Mumford Susan Robinson Dora Foukanelli Nick Torpey Rutger J. Ploeg Nizam Mamode Michael F. Murphy Colin Brown David J. Roberts Fiona Regan Michelle Willicombe Michelle Willicombe |
| author_facet | Sevda Hassan Sevda Hassan Lisa Mumford Susan Robinson Dora Foukanelli Nick Torpey Rutger J. Ploeg Nizam Mamode Michael F. Murphy Colin Brown David J. Roberts Fiona Regan Michelle Willicombe Michelle Willicombe |
| author_sort | Sevda Hassan |
| collection | DOAJ |
| description | BackgroundPatient Blood Management (PBM), endorsed by the World Health Organisation is an evidence-based, multi-disciplinary approach to minimise inappropriate blood product transfusions. Kidney transplantation presents a particular challenge to PBM, as comprehensive evidence of the risk of transfusion is lacking. The aim of this study is to investigate the prevalence of post-transplant blood transfusions across multiple centres, to analyse risk factors for transfusion and to compare transplant outcomes by transfusion status.MethodsThis analysis was co-ordinated via the UK Transplant Registry within NHS Blood and Transplant (NHSBT), and was performed across 4 centres. Patients who had received a kidney transplant over a 1-year period, had their transfusion status identified and linked to data held within the national registry.ResultsOf 720 patients, 221(30.7%) were transfused, with 214(29.7%) receiving a red blood cell (RBC) transfusion. The proportion of patients transfused at each centre ranged from 20% to 35%, with a median time to transfusion of 4 (IQR:0-12) days post-transplant. On multivariate analysis, age [OR: 1.02(1.01-1.03), p=0.001], gender [OR: 2.11(1.50-2.98), p<0.0001], ethnicity [OR: 1.28(1.28-2.60), p=0.0008], and dialysis dependence pre-transplant [OR: 1.67(1.08-2.68), p=0.02], were associated with transfusion. A risk-adjusted Cox proportional hazards model showed transfusion was associated with inferior 1-year patient survival [HR 7.94(2.08-30.27), p=0.002] and allograft survival [HR: 3.33(1.65-6.71), p=0.0008], and inferior allograft function.ConclusionRBC transfusions are common and are independently associated with inferior transplant outcomes. We urge that further research is needed to understand the mechanisms behind the outcomes, to support the urgent development of transplant-specific anaemia guidelines. |
| first_indexed | 2024-03-12T22:06:29Z |
| format | Article |
| id | doaj.art-d52319a301af444e911fac7f8425e290 |
| institution | Directory Open Access Journal |
| issn | 2813-0626 |
| language | English |
| last_indexed | 2024-03-12T22:06:29Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nephrology |
| spelling | doaj.art-d52319a301af444e911fac7f8425e2902023-07-24T11:29:36ZengFrontiers Media S.A.Frontiers in Nephrology2813-06262023-07-01310.3389/fneph.2023.12365201236520Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood managementSevda Hassan0Sevda Hassan1Lisa Mumford2Susan Robinson3Dora Foukanelli4Nick Torpey5Rutger J. Ploeg6Nizam Mamode7Michael F. Murphy8Colin Brown9David J. Roberts10Fiona Regan11Michelle Willicombe12Michelle Willicombe13Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United KingdomImperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United KingdomStatistics and Clinical Studies, National Health Service (NHS) Blood and Transplant, Bristol, United KingdomDepartment of Haematology, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United KingdomDepartment of Haematology, Addenbrooke’s Hospital, Cambridge, United KingdomDepartment of Clinical Nephrology and Transplantation, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomDepartment of Surgery, Nuffield Department of Surgical Science, University of Oxford, Oxford, United KingdomDepartment of Transplantation, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United KingdomNational Health Service (NHS) Blood and Transplant, and Nuffield Department of Clinical and Laboratory Sciences, University of Oxford, Oxford, United Kingdom0Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom0Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom0Haematology, National Health Service (NHS) Blood and Transplant, London, United KingdomCentre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United KingdomImperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United KingdomBackgroundPatient Blood Management (PBM), endorsed by the World Health Organisation is an evidence-based, multi-disciplinary approach to minimise inappropriate blood product transfusions. Kidney transplantation presents a particular challenge to PBM, as comprehensive evidence of the risk of transfusion is lacking. The aim of this study is to investigate the prevalence of post-transplant blood transfusions across multiple centres, to analyse risk factors for transfusion and to compare transplant outcomes by transfusion status.MethodsThis analysis was co-ordinated via the UK Transplant Registry within NHS Blood and Transplant (NHSBT), and was performed across 4 centres. Patients who had received a kidney transplant over a 1-year period, had their transfusion status identified and linked to data held within the national registry.ResultsOf 720 patients, 221(30.7%) were transfused, with 214(29.7%) receiving a red blood cell (RBC) transfusion. The proportion of patients transfused at each centre ranged from 20% to 35%, with a median time to transfusion of 4 (IQR:0-12) days post-transplant. On multivariate analysis, age [OR: 1.02(1.01-1.03), p=0.001], gender [OR: 2.11(1.50-2.98), p<0.0001], ethnicity [OR: 1.28(1.28-2.60), p=0.0008], and dialysis dependence pre-transplant [OR: 1.67(1.08-2.68), p=0.02], were associated with transfusion. A risk-adjusted Cox proportional hazards model showed transfusion was associated with inferior 1-year patient survival [HR 7.94(2.08-30.27), p=0.002] and allograft survival [HR: 3.33(1.65-6.71), p=0.0008], and inferior allograft function.ConclusionRBC transfusions are common and are independently associated with inferior transplant outcomes. We urge that further research is needed to understand the mechanisms behind the outcomes, to support the urgent development of transplant-specific anaemia guidelines.https://www.frontiersin.org/articles/10.3389/fneph.2023.1236520/fulltransfusionkidney transplantbloodanaemiaoutcomes cRFcalculated reaction frequency DSA |
| spellingShingle | Sevda Hassan Sevda Hassan Lisa Mumford Susan Robinson Dora Foukanelli Nick Torpey Rutger J. Ploeg Nizam Mamode Michael F. Murphy Colin Brown David J. Roberts Fiona Regan Michelle Willicombe Michelle Willicombe Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management Frontiers in Nephrology transfusion kidney transplant blood anaemia outcomes cRF calculated reaction frequency DSA |
| title | Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management |
| title_full | Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management |
| title_fullStr | Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management |
| title_full_unstemmed | Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management |
| title_short | Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival—it is time for rigorous patient blood management |
| title_sort | blood transfusions post kidney transplantation are associated with inferior allograft and patient survival it is time for rigorous patient blood management |
| topic | transfusion kidney transplant blood anaemia outcomes cRF calculated reaction frequency DSA |
| url | https://www.frontiersin.org/articles/10.3389/fneph.2023.1236520/full |
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