An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival

Abstract

BackgroundBlood transfusions have the potential to improve graft survival, induce sensitization, and transmit infections. Current clinical practice is to minimize transfusions in renal transplantation candidates, but it is unclear if the evidence continues to support pre-transplant transfusion avoidance. Changes in the Medicare prospective payment system may increase transfusion rates. Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates.MethodsA review applying a systematic approach and conducted using MEDLINE®, Embase®, and the Cochrane Library for English-language publications (timeframe: 01/1984–03/2011) captured 180 studies and data from publically available registries and assessed the impact of transfusions on allosensitization and graft survival, and the impact of allosensitization on graft survival and wait time.ResultsBlood transfusions continued to be a major cause of allosensitization, with allosensitization associated with increased rejection and graft loss, and longer wait times to transplantation. Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice. Recent data suggested that it may be the donor-specific antibody component of allosensitization that carried the risk to graft outcomes.ConclusionsResults of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

Clinical Outcome of Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease

“…The KT procedure performed after or before native nephrectomy means 2 consecutive major operations for patients. In addition, when native nephrectomy is performed before KT, blood transfusion may be required, which may result in presensitization that can complicate scheduled transplantation [9]. In addition, repeated operations may decrease native kidney residual function, which is also important for long-term allograft and patient outcomes even after transplantation [4,10].…”

Mobilizing pre-heart-transplant patients with a percutaneously placed axillary-subclavian intraaortic balloon pump: A retrospective study

“…Laboratory tests, like the basic metabolic panel and complete blood cell count, were done every other day to minimize risk of infection, blood loss, and the need for transfusion. [16] Chest x-rays were done every day. If there was a need for repositioning of the PAIABP, it was done by the cardiologists at the bedside.…”

Living donor renal transplant in a patient with end-stage renal disease due to Hermansky-Pudlak syndrome

“…Our case was complex as there was a significant risk of perioperative blood loss as well as thrombosis. Allosensitisation is associated with increased rejection and graft loss 8. Similarly increased thrombotic risk may result in allograft renal vein thrombosis.…”