Original article

Ahead-of-Print

Challenges in perioperative blood transfusions in kidney transplantation and the need for Patient Blood Management

Authors

Key words: blood transfusion, kidney transplantation, anemia, Patient Blood Management
Publication Date: 2023-10-09

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 applying Patient Blood Management (PBM) guidelines. 

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. We recorded donor and recipient characteristics, cold ischemia time, preoperative hemoglobin concentration, iron status deficiency biomarkers, the 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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Authors

Diana Rodríguez Espinosa - Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain

José Jesús Broseta - Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain https://orcid.org/0000-0002-4559-9083

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 https://orcid.org/0000-0002-0358-9370

Beatriz Tena - Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain https://orcid.org/0000-0001-9325-0858

Elena Cuadrado-Payán - Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain https://orcid.org/0000-0003-2412-6911

Ramsés Ramero - Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain https://orcid.org/0000-0003-3054-1345

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 https://orcid.org/0000-0001-6199-3016

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 https://orcid.org/0000-0002-6962-8184

Misericordia Basora - Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain https://orcid.org/0000-0002-1892-5330

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