From the Guidelines
Renal transplant and blood transfusion considerations are crucial to prevent sensitization and ensure compatibility. When considering a renal transplant, it is essential to evaluate the risks and benefits of blood transfusions, as they can cause sensitization to HLA antigens, making it more challenging to find a compatible donor [ 1 ].
Key Considerations
- Blood group compatibility: The blood group of the recipient should be compatible with that of the donor to prevent hyperacute rejection and graft failure [ 1 ].
- Sensitization risk: Blood transfusions can cause sensitization to HLA antigens, which can make it more difficult to find a compatible donor [ 1 ].
- Nephrectomy: In some cases, nephrectomy may be necessary to remove a failed allograft, which can help minimize immunosuppression and reduce the risk of sensitization [ 1 ].
- Embolization: Embolization of the allograft renal artery is an alternative to transplant nephrectomy and may pose lower risks to patients with a failed allograft [ 1 ].
Transfusion-Related Considerations
- Transfusion rates: Blood transfusion rates can be high in patients undergoing nephrectomy, with rates as high as 9.1% [ 1 ].
- Bleeding risks: Patients with a failed allograft are at risk of bleeding, and transfusions may be necessary to manage bleeding episodes [ 1 ].
Clinical Practice Recommendations
- Individualized approach: A case-by-case approach is recommended when considering nephrectomy or embolization in patients with a failed allograft [ 1 ].
- Delayed kidney transplantation: Delayed kidney transplantation may be considered in patients undergoing combined liver-kidney transplantation to minimize the risk of bleeding and improve outcomes [ 1 ].
From the Research
Considerations for Renal Transplant and Blood Transfusion
- Blood transfusions have the potential to improve graft survival, induce sensitization, and transmit infections 2
- Current clinical practice is to minimize transfusions in renal transplantation candidates, as allosensitization associated with blood transfusions can lead to increased rejection and graft loss, and longer wait times to transplantation 2
- Avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation 2
Risk Factors for Blood Transfusion in Kidney Transplantation
- Anemia is highly prevalent in end-stage chronic kidney disease patients, increasing their risk of receiving blood transfusions during and after kidney transplant surgery 3
- Iron status upon admission is associated with the transfusion of more blood units 3
- Surgical reintervention and deceased donor donation are associated with an increased risk of transfusion 3
- A higher number of blood units transfused is associated with impaired kidney graft function six months after hospital discharge 3
Historical Context of Blood Transfusions in Renal Transplantation
- The beneficial effect of blood transfusions on the prognosis of renal transplantation was recognized in 1972, leading to the adoption of systematic transfusion policies in end-stage renal disease patients requiring a graft 4, 5
- However, the improvement in transplantation results and the disappearance of transfusions prescribed in hemodialyzed patients after recombinant human erythropoietin became available have raised questions about the transfusion policy 4
Impact of Blood Transfusions on Graft Outcomes
- Blood transfusions in organ donors after neurologic determination of death may translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF) 6
- Grafts from transfused donors have a lower rate of DGF compared to those from non-transfused donors 6
- Any blood transfusion in a donor is associated with a 23% decrease in the odds of recipients developing DGF, and this effect is more pronounced as the number of blood transfusions increases 6