Early Post-Transplant Red Blood Cell Transfusion Is Associated With an Increased Risk of Transplant Failure: A Nationwide French Study

Abstract

BackgroundRed 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.MethodsWe 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.ResultsAmong 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.ConclusionsEarly red blood cell transfusion after kidney transplantation is associated with increased transplant failure.

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

“…We conducted a national longitudinal study to investigate the association between RBC storage duration and transplant outcomes after early posttransplant RBCT in France. 7…”

“…We conducted a national longitudinal study to investigate the association between RBC storage duration and transplant outcomes after early posttransplant RBCT in France . Detailed patient characteristics and blood product characteristics for each unit of transfused blood were extracted from national databases.…”

“…In previous studies, this association only appeared after the third RBC unit. 7,45 The difference may either be related to a smaller number of patients or different transfusion practices in these studies. The association of time elapsed between transplant and transfusion is also probably influenced by differences in the context and indication of transfusion.…”

“…Although most transfusions (72%) concerned 1 or 2 RBC units, we and others reported that the harmful association of the transfusion was proportional to the number RBC unit transfused. 7,[43][44][45][46] The association between the need for a massive transfusion and severe posttransplant complications is obvious. However, the deleterious association of the transfusion starts with the first transfusion episode (1 or 2 RBC units).…”

“…Several contradictory publications have focused on the impact of posttransplant transfusion, questioning transfusion-mediated development of anti-human leukocyte antigen (HLA) antibodies and antibody-mediated rejection in presensitized patients. [2][3][4][5][6] Using a national cohort of more than 12 000 patients, we recently reported 7 that red blood cell transfusion (RBCT) early after transplantation was associated with transplant failure.…”