Anemia occurs before and after kidney transplantation. Determining the impact of perioperative transfusion on post-transplant outcomes can help determine best management of anemia. The current study aims to describe clinical outcomes associated with packed red blood cell transfusions in the peri-operative management of anemia after transplantation. This was a single-center, retrospective study of adult kidney recipients with anemia at the time of transplantation. 1271 patients were stratified by donor-type due to the potential variability in underlying recipient and transplant characteristics; living donor (n = 698, 62%) or deceased donor (n = 573, 38%). Living donor recipients that received blood during the index hospitalization were more likely to experience rejection within 30 days (18% vs. 10%, p = 0.008) and 1 year of transplant (32% vs. 16%, p = 0.038). In multivariate analysis, receiving both blood and darbepoetin (HR: 1.89 [1.20,3.00], p = 0.006), age at transplant (HR: 0.98 [0.97, 0.99], p = 0.02), number of HLA mismatches (HR: 1.17 [1.05,1.30], p = 0.003), and whether the case was a repeat transplant (HR: 2.77 [1.93,3.97], p < 0.01) were significantly associated with hazard of rejection. For deceased donor recipients, there were no differences in acute rejection, graft failure or mortality at 30 days or 1 year. When analyzing hazard of rejection in a multivariate model, treatment received was not found to be significantly associated with rejection. Our findings suggest there may be a role for more aggressive pre-transplant treatment of anemia for those patients undergoing living donor transplants.

中文翻译：

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围手术期红细胞输注治疗贫血对肾移植受者急性排斥反应的影响


贫血发生在肾移植前后。确定围手术期输血对移植后结果的影响有助于确定贫血的最佳治疗方法。目前的研究旨在描述移植后贫血围手术期管理中与浓缩红细胞输注相关的临床结果。这是一项针对移植时患有贫血的成年肾受者的单中心回顾性研究。由于潜在的受者和移植特征存在潜在差异，1271 名患者按供体类型进行了分层；活体捐赠者（n = 698，62%）或已故捐赠者（n = 573，38%）。在指数住院期间接受血液的活体捐献者更有可能在移植后 30 天（18% vs. 10%，p = 0.008）和 1 年内（32% vs. 16%，p = 0.038）发生排斥反应。在多变量分析中，同时接受血液和达贝泊汀（HR：1.89 [1.20,3.00]，p = 0.006），移植时年龄（HR：0.98 [0.97，0.99]，p = 0.02），HLA 不匹配数量（HR：1.17） [1.05,1.30]，p = 0.003）以及病例是否重复移植（HR：2.77 [1.93,3.97]，p < 0.01）与排斥风险显着相关。对于已故的供体受者来说，30 天或 1 年后的急性排斥反应、移植失败或死亡率没有差异。在分析多变量模型中的排斥风险时，未发现接受的治疗与排斥显着相关。我们的研究结果表明，对于接受活体移植的患者来说，更积极的移植前贫血治疗可能会发挥作用。