Retrospective analysis of perioperative transfusion requirements in living donor renal transplantation

Makroo, Raj Nath; Kakkar, Brinda; Chowdhry, Mohit; Nayak, Subhashree; Bhatia, Aakanksha

doi:10.1016/j.transci.2016.03.004

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Er (Epo) use was similar in both groups, thus not explaining a difference in preoperative Hb. While others have found preoperative Hb to be the most predictive for perioperative blood transfusion in RT, preoperative Hb was not correlated with blood transfusion in our matched cohort.…”

Section: Discussioncontrasting

confidence: 93%

Intraoperative blood transfusion in pediatric patients undergoing renal transplant—Effect of renal graft size

Odeh

Sidler

Skelton

et al. 2018

Pediatric Transplantation

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In pediatric RT, donor allograft size often exceeds the expected recipient norms, especially in younger recipients. An "oversize" graft might not only present a technical- and space-related challenge, but may possibly lead to increased demands in perioperative volume requirements due to the disparity between donor and recipient in renal blood flow. We evaluated transfusion practices at a single tertiary institution with special consideration of kidney graft size, hypothesizing that oversize graft kidneys might lead to a quantifiable increased need of blood transfusion in smaller recipients. Retrospective analysis of all patients who underwent pediatric RT from January 2004 to June 2014 at a tertiary pediatric centre was performed. Variables analyzed included patient age, weight, pre- and postoperative Hb concentration, graft size, EBL, amount of intraoperative blood transfusion, and preoperative use of erythropoietin. Based on graft size in relation to patient's age, a SMR and an OvR were identified. A subcohort of age-matched pairs was used to allow for comparison between groups. We calculated the expected procedure- and transfusion-induced changes in Hb and compared these changes to the observed difference in pre- vs postoperative Hb to assess the influence of graft size on transfusion requirements. RT was performed in 188 pediatric recipients during the study period. In the matched cohort, percentage of transfused patients during transplantation in the OvR group was more than double compared with SMR (89% vs 39%, P < .001); similarly, the median number of transfused PRBC units in OvR was 1, while the median of SMR did not receive transfusion (P < .001). The difference between expected (calculated) and observed change in Hb was significantly higher in OvR with a median of 1.9 g/dL compared with SMR with a median of 1.0 g/dL (P = .026). Correspondingly, the calculated median volume taken up by a regular size kidney was significantly higher with 213 mL compared with 313 mL (P = .031) taken up by an oversize graft kidney. Median estimated intraoperative blood loss was significantly higher in OvR than in SMR (6.9 mL/kg, vs 5.3 mL/kg, respectively; P = .04). Median postoperative Hb was similar among groups (10.4 g/dL vs 10.6 g/dL for SMR vs OvR, respectively). Transplantation of an oversized kidney in pediatric RT recipients is associated with a quantifiable higher need for blood transfusion. This may be caused by a higher intraoperative EBL and/or greater blood volume sequestered by the larger renal allograft and requires further evaluation.

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Section: Discussioncontrasting

confidence: 93%

Intraoperative blood transfusion in pediatric patients undergoing renal transplant—Effect of renal graft size

Odeh

Sidler

Skelton

et al. 2018

Pediatric Transplantation

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“…Anemia is common in patients with ESRD [34]. Similarly, in the present study, most of the patients had anemia [35]. However, blood transfusion was performed in only seven (7.8%) patients.…”

Section: Discussionsupporting

confidence: 72%

Anesthetic Management of Patients Undergoing Renal Transplantation: A Review of A Two-year Experience

2020

Signa Vitae

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Objectives: This study reviewed the anesthetic management procedures used for renal transplantation patients at a university hospital in Turkey over a two-year period. Areas of interest included preoperative status, fluid management, perioperative complications, and postoperative analgesia. Methods: A retrospective review of hospital records and information collected from all patients undergoing renal transplantation, performed at Ondokuz Mayıs University Hospital from 2018 to 2020, was conducted. Results: A total of 90 renal transplants were performed during the study time period. Of the patients undergoing renal transplantation, 44.4% were female and 55.6% were male. 52 patients were recipients of cadaveric transplants and 38 patients received kidneys from living, related donors. The duration of surgery and cold ischemic time were longer in the recipients of the cadaveric transplants (p < 0.05). Delayed graft function was statistically significantly higher in the kidney transplants obtained from the cadaveric donors than the living donors (p < 0.05). Conclusions: This study showed that anesthesia for renal transplantation is a safe and effective method if a selected range of drugs and techniques is used. Applying a well-planned standard anesthesia protocol and updating it periodically in line with the current literature will contribute to improving the quality of the outcomes renal transplantation surgery.

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“…These factors are consistent with those reported in the literature: increased risk of transfusion in renal transplant has previously been linked to warfarin/antiplatelet agents, older age, lower preoperative Hb, autosomal polycystic kidney disease, and duration of hospital stay. 1,3,10,15,16 Interestingly, we found that female gender was significantly associated with blood transfusion within our cohort. This has been inconclusively demonstrated in the literature with retrospective studies demonstrating effects in both directions.…”

Section: Discussionmentioning

confidence: 51%

“…Contemporary evidence suggests that transfusion rates are quite variable, ranging between 10% and 75%. 1 –5 This variability is due in part to differing postoperative durations: some are reported up to 30 days postoperatively, making it difficult to determine the real-world necessity for up-front preoperative crossmatch for intraoperative and immediate postoperative use. As a result, the need for a routine crossmatch prior to all renal transplantation is likely overstated, and the opportunity exists to tailor this to a patient’s individualized risk profile.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Necessity of Routine Crossmatching for Blood Transfusion in Renal Transplantation

et al. 2020

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Introduction: Routine crossmatch of packed red blood cells (pRBCs) is completed preoperatively at many centers despite conflicting evidence on the incidence of blood transfusions with renal transplantation. In the current economic climate, resource adjudication should be judicious and medically appropriate. The objective of this study was to determine the incidence, timing, and predictors of early postoperative pRBC transfusion in patients undergoing renal transplantation. Methods: A retrospective review of all patients undergoing renal transplantation at our institution from January 2013 to May 2016 was performed. Demographic, biochemical, and clinical parameters were recorded. The primary outcome was early postoperative transfusion, defined as an intraoperative transfusion or within 2 days of surgery. Multivariable logistic regression was performed to identify associations with early postoperative transfusion. Results: We identified 428 patients during the study period (average age 55 years, 60% male, 30% obese, 67% deceased donor, and 43% preoperative antithrombotic use). Forty (9.3%) patients required early postoperative transfusion (mean: 2.8 pRBCs/transfusion) and most did not require blood urgently. Only 20 (4.7%) patients required a transfusion intraoperatively or on the same day of surgery. Lower preoperative hemoglobin (per g/L unit: odds ratio [OR]: 0.943), female gender (OR: 2.752), and preoperative antithrombotic use (OR 2.369) were associated with a need for early postoperative transfusion. Conclusion: Transfusion in the early postoperative period following renal transplantation was less than 10%, suggesting that routine crossmatch may not be necessary for all patients. Preoperative hemoglobin, female gender, and preoperative antithrombotic use were associated with increased risk and may be useful to risk-stratify patients who require crossmatch.

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Retrospective analysis of perioperative transfusion requirements in living donor renal transplantation

Cited by 5 publications

References 13 publications

Intraoperative blood transfusion in pediatric patients undergoing renal transplant—Effect of renal graft size

Intraoperative blood transfusion in pediatric patients undergoing renal transplant—Effect of renal graft size

Anesthetic Management of Patients Undergoing Renal Transplantation: A Review of A Two-year Experience

Assessing the Necessity of Routine Crossmatching for Blood Transfusion in Renal Transplantation

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