Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study

doi:10.5500/wjt.v13.i4.157

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World Journal of Transplantation

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Transplant. Jun 18, 2023; 13(4): 157-168
Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.157

Table 1 Baseline characteristics of both the transfusion and non-transfusion groups, n (%)

	Total cohort, 105	Non-transfusion, 51 (48.6%)	Transfusion, 54 (51.4%)	P value
Age (mean ± SD)	39.7 ± 14.5	40.5 ± 13.9	38.9 ± 15.1	0.583
Gender
Female	28 (26.7)	10 (19.6)	18 (33.3)	0.127
Male	77 (73.3)	41 (80.4)	36 (66.7)	0.127
Type of transplantation
LRKTx	84 (80)	43 (84.3)	41 (75.9)	0.566
LURKTx	15 (14.3)	6 (11.8)	9 (16.7)
DDKTx	6 (5.7)	2 (3.9)	4 (7.4)
HLA mismatch	3 (1-4)	3 (0-4)	3 (2-4)	0.152
Cause of ESRD
Diabetes	18 (17.1)	7 (13.7)	11 (20.4)	0.331
GN	26 (24.8)	11 (21.6)	15 (27.8)
Hypertension	18 (17.1)	12 (23.5)	6 (11.1)
PCKD	1 (1)	1 (2)	0 (0)
Urological	7 (6.7)	2 (3.9)	5 (9.3)
Other	35 (33.3)	18 (35.3)	17 (31.5)
Donor's age	33 ± 8.6	32.4 ± 8.4	33.5 ± 8.8	0.562
Induction therapy
ATG	42 (40)	21 (41.2)	21 (38.9)	1
Basiliximab	62 (59)	30 (58.8)	32 (59.3)
No induction	1 (1)	0 (0)	1 (1.9)
Maintenance immunosuppression
CNI used tacrolimus	105 (100)	51 (100)	54 (100)
Average CNI level	7 (6-8)	7 (6-8)	7 (6-8)	0.743
Antimetabolite used (MMF)	105 (100)	51 (100)	54 (100)

LRKTX: Living-related kidney transplantation; LURKTx: Living non-related kidney transplantation; DDKTX: Deceased-donor kidney transplantation; HLA: Human leucocyte antigen; ESRD: End-stage renal disease; GN: Glomerulonephritis; PCKD: Polycystic kidney disease; ATG: Antithymocyte globulin; CNI: Calcineurin inhibitor; MMF: Mycophenolate mofetil.

Table 2 Blood transfusion information

	Total, 105	Non-transfused, 51 (48.6%)	Transfused, 54 (51.4%)	P value
Hemoglobin at transplantation	10.5 ± 1.7	11.2 ± 1.6	9.8 ± 1.6	< 0.001
Hemoglobin at blood transfusion			7.4 ± 0.9
Hemoglobin after transfusion			9.2 ± 1.1
Number of blood transfusion units given	1 (0-1.5)		1 (0-1.5)

Table 3 Infectious and non-infectious complications among the two groups, n (%)

	Total, 105	Non-transfusion, 51 (48.6%)	Transfusion, 54 (51.4%)	P value
No. of infections	0 (0-1)	1 (0-1)	0 (0-1.25)	0.554
Types of infections
none	55 (52.4)	25 (49)	30 (55.6)	0.745
UTI	30 (28.6)	14 (27.5)	16 (29.6)	0.832
Pnemonia	1 (1)	1 (2)	0 (0)	0.486
TB	1 (1)	0 (0)	1 (1.9)	1
BK	7 (6.7)	5 (9.8)	2 (3.7)	0.261
Bactremia	4 (3.8)	1 (2)	3 (5.6)	0.618
Epidediymo-orchitis	2 (1.9)	1 (2)	1 (1.9)	1
Gastroenteritis	2 (1.9)	2 (3.9)	0 (0)	0.234
Herpes zoster	1 (1)	0 (0)	1 (1.9)	1
Infected AVF	1 (1)	1 (2)	0 (0)	0.486
Perianal abcess	1 (1)	1 (2)	0 (0)	0.486
COVID-19	9 (8.6)	6 (11.8)	3 (5.6)	0.311
URTI	2 (1.9)	1 (2)	1 (1.9)	1
CMV	12 (11.4)	6 (11.8)	6 (11.1)	1
Urological complications
None	95 (90.5)	49 (96.1)	46 (85.2)	0.484
Allograft artery stenosis	1 (1)	0 (0)	1 (1.9)
Collection	3 (2.9)	1 (2)	2 (3.7)
Lymphocele	1 (1)	0 (0)	1 (1.9)
Obstrctive uropathy	1 (1)	0 (0)	1 (1.9)
Perinephric collection and ureteric stricture	2 (1.9)	0 (0)	2 (3.7)
Unrogenic bladder	1 (1)	0 (0)	1 (1.9)
Urinary leak	1 (1)	1 (2)	0 (0)
Urological complications
No	95 (90.5)	49 (96.1)	46 (85.2)	0.094
Yes	10 (9.5)	2 (3.9)	8 (14.8)	0.094
CNI withdrawal	1 (1)	0 (0)	1 (1.9)	1
Duration from Tx	3 d
MMF withdrawal	1 (1)	0 (0)	1 (1.9)	1
Duration from Tx	3 d
Steroids withdrawal	0 (0)	0 (0)	0 (0)

UTI: Urinary tract infection; TB: Tuberculosis; AVF: Arterio-venous fistula; COVID-19: Coronavirus disease 2019; URTI: Upper respiratory tract infection; CMV: Cytomegalovirus; CNI: Calcineurin inhibitor; MMF: Mycophenolate mofetil.

Table 4 Comparison in Outcomes of transplantation between the two groups, n (%)

	Total, 105	Non-transfusion, 51 (48.6%)	Transfusion, 54 (51.4%)	P value
Rejection	5 (4.8)	2 (3.9)	3 (5.6)	1
Rejection type
ABMR	2 (40)	1 (50)	1 (33.3)	1
Cellular	3 (60)	1 (50)	2 (66.7)	1
Graft loss	4 (3.8)	1 (2)	3 (5.6)	0.618
Death	2 (1.9)	1 (2)	1 (1.9)	1
DGF	11 (10.5)	2 (3.9)	9 (16.7)	0.053
Serum creatinine
At discharge	141 ± 124.1	123 ± 56.7	158 ± 163	0.770
6 mo	108 ± 40.7	107.1 ± 28	108.9 ± 50.4	0.825
12 mo	109.1 ± 51.3	101.9 ± 22.9	117 ± 69.8	0.182
18 mo	126 ± 168.7	106.2 ± 26.5	147.4 ± 241.5	0.735
Creatinine difference: At 18 mo-at discharge		-19.4 ± 61.5	12.3 ± 253.8	0.439

ABMR: Antibody-mediated rejection; DGF: Delayed-graft function.

Table 5 Characteristics of rejection developers vs non-rejection developers among the study cohort, n (%)

	Non-rejection, 100	Rejection, 5	P value
Age (mean ± SD)	36.5 (28.25-51.75)	36 (21-46.5)	0.383
Gender
Female	28 (28)	0 (0)	0.321
Male	72 (72)	5 (100)	0.321
Type of transplantation
LRKTx	81 (81)	3 (60)	0.172
LURKTx	13 (13)	2 (40)
DDKTx	6 (6)	0 (0)
HLA mismatch	3 (1-4)	3 (1-4)	0.729
Cause of ESRD
Diabetes	18 (18)	0 (0)	0.199
GN	23 (23)	3 (60)
Hypertension	18 (18)	0 (0)
PCKD	1 (1)	0 (0)
Urological	6 (6)	1 (20)
Other	34 (34)	1 (20)
Donor's age	32 (26-39)	28 (25.5-43.5)	0.981
Induction therapy
ATG	41 (41)	1 (20)	0.438
Basiliximab	58 (58)	4 (80)
No induction	1 (1)	0 (0)
Average CNI level	7 (6-8)	8 (6.5-9)	0.311
Hb at transplantation	10.65 (9.025-11.3)	10.7 (9.05-12.45)	0.792
Hb at blood transfusion	7.4 (6.8-8)	7.8¹	0.138
Hb after transfusion	8.9 (8.4-10)	10¹	0.382
No of blood transfusion unites given	1 (0-1)	1 (0-3)	0.491
Serum creatinine
At discharge	111 (83.25-142.75)	151 (113.5-222.5)	0.096
6 mo	102.5 (80.5-123)	120 (80-156)	0.420
12 mo	99.5 (81.75-119.25)	124.5 (92.5-140.75)	0.201
18 mo	105 (84.25-119)	107 (72-)	0.894
Death	1 (1)	1 (20)	0.093
DGF	9 (9)	2 (40)	0.084
No. of infections	0 (0-1)	1 (0-2)	0.651
Types of infections
None	53 (53)	2 (40)	0.188
UTI	30 (28.6)	29 (29)	1
Pnemonia	1 (1)	1 (1)	1
TB	1 (1)	1 (1)	1
BK	7 (6.7)	7 (7)	1
Bactremia	4 (3.8)	4 (4)	1
Epidediymo-orchitis	2 (1.9)	2 (2)	1
Gastroenteritis	2 (1.9)	1 (1)	0.093
Herpes zoster	1 (1)	1 (1)	1
Infected AVF	1 (1)	1 (1)	1
Perianal abcess	1 (1)	1 (1)	1
COVID-19	9 (8.6)	8 (8)	0.367
URTI	2 (1.9)	1 (1)	0.093
CMV	11 (11)	1 (20)	0.462
Urological complications
None	90 (90)	5 (100)	1
Allograft artery stenosis	1 (1)	0 (0)
Collection	3 (3)	0 (0)
Lymphocele	1 (1)	0 (0)
Obstrctive uropathy	1 (1)	0 (0)
Perinephric collection and ureteric stricture	2 (2)	0 (0)
Unrogenic bladder	1 (1)	0 (0)
Urinary leak	1 (1)	0 (0)
Urological complications
No	90 (90)	5 (100)	1
Yes	10 (10)	0 (0)	1

¹Interquartile range could not be calculated due to small number of patients for this outcome.

COVID-19: Coronavirus disease 2019; LRKTX: Living-related kidney transplantation; LURKTx: Living non-related kidney transplantation; DDKTX: Deceased-donor kidney transplantation; HLA: Human leucocyte antigen; ESRD: End-stage renal disease; GN: Glomerulonephritis; PCKD: polycystic kidney disease; ATG: Antithymocyte globulin; CNI: Calcineurin inhibitor; MMF: Mycophenolate mofetil; Hb: Hemoglobin; DGF: Delayed-graft function; UTI: Urinary tract infection; TB: Tuberculosis; AVF: Arterio-venous fistula; URTI: Upper respiratory tract infection; CMV: Cytomegalovirus.

Table 6 Multiple linear regression analysis of the association between creatinine change and eligible study variables

	B	SE	95%CI	P value
(Intercept)	70.23	18.72	33.54 to 106.92	< 0.001
Male vs female	-1.74	18.59	-38.17 to 34.69	0.925
No. of PRBCs	20.14	6.99	6.45 to 33.84	0.004
Creatinine at discharge	-0.79	0.12	-1.03 to -0.54	< 0.001

CI: Confidence interval; PRBC: Packed red blood cell.

Citation: Bukhari MA, Alhomayani FK, Al Eid HS, Al-Malki NK, Alotaibi ME, Hussein MA, Habibullah ZN. Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study. World J Transplant 2023; 13(4): 157-168
URL: https://www.wjgnet.com/2220-3230/full/v13/i4/157.htm
DOI: https://dx.doi.org/10.5500/wjt.v13.i4.157