J Korean Med Sci.  2023 Jul;38(28):e212. 10.3346/jkms.2023.38.e212.

Associations of Perioperative Red Blood Cell Transfusion With Outcomes of Kidney Transplantation in Korea Over a 16-Year Period

• Kim Y
• Kim B
• Kang M
• Nam H
• Ko DH
• Park Y

• KMID: 2544473
• DOI: http://doi.org/10.3346/jkms.2023.38.e212

Abstract

Background
This study investigated the associations between transfusion of different types of red blood cell (RBC) preparations and kidney allograft outcomes after kidney transplantation (KT) over a 16-year period in Korea using a nationwide population-based cohort.
Methods
We investigated the reported use of RBCs during hospitalization for KT surgery, rejection, and graft failure status using nationwide data from the National Health Information Database (2002–2017). The associations between the type of perioperative RBC product and transplant outcomes were evaluated among four predefined groups: no RBC transfusion, filtered RBCs, washed RBCs, and packed RBCs (pRBCs).
Results
A total of 17,754 KT patients was included, among which 8,530 (48.0%) received some type of RBC transfusion. Of the patients who received RBC transfusion, 74.9%, 19.7%, and 5.4% received filtered RBCs, pRBCs, or washed RBCs, respectively. Regardless of the type of RBC products, the proportions of acute rejection and graft failure was significantly greater in patients receiving transfusion (P < 0.001). Cox proportional hazards regression analyses showed that the filtered RBC and pRBC groups were significantly associated with both rejection and graft failure. The washed RBC group also had hazard ratios greater than 1.0 for rejection and graft failure, but the association was not significant. Rejection-free survival of the pRBC group was significantly lower than that of the other groups (P < 0.001, log-rank test), and graft survival for the no RBC transfusion group was significantly greater than in the other groups (P < 0.001, log-rank test).
Conclusion
Perioperative RBC transfusion was associated with poor graft outcomes. Notably, transfusion of pRBCs significantly increased transplant rejection. Therefore, careful consideration of indications for RBC transfusion and selection of the appropriate type of RBCs is necessary, especially for patients at high risk of rejection or graft failure.

Keyword

Kidney Transplantation; Blood Transfusion; Red Blood Cell; Graft Survival

Figure

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  Fig. 1 Rejection-free survival according to the type of RBCs transfused perioperatively at kidney transplantation. Patients transfused with packed RBCs showed poorer rejection-free survival than the other groups (log-rank test, P < 0.001).RBC = red blood cell.

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  Fig. 2 Kidney allograft survival according to the type of RBCs transfused perioperatively at kidney transplantation. The patients who did not receive any RBC product perioperatively showed longer overall graft survival than the groups being transfused with filtered RBCs, washed RBCs, or packed RBCs (P < 0.001 for each comparison). Graft survival was not significantly different among the groups transfused with different types of RBC preparations.RBC = red blood cell.

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