Peri-Operative Hemoglobin, Blood Transfusion and Delayed Graft Function in Kidney Transplant Recipients

S. MacIsaac, A. Ramankumar, C. Saw, V. Naessens, M. Cantarovich, D. Baran, S. Paraskevas, J. Tchervenkov, P. Chaudhury, S. Sandal.

MUHC, Montreal, Canada.

Meeting: 2018 American Transplant Congress

Abstract number: D135

Keywords: Blood transfusion, Kidney transplantation, Renal dysfunction, Renal injury

Session Information

Session Name: Poster Session D: Kidney Donor Selection / Management Issues

Session Type: Poster Session

Date: Tuesday, June 5, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background: Studies in the non-kidney transplant (KT) literature support an absolute hemoglobin concentration (Hb) threshold of 70 g/L for transfusion, unless otherwise indicated. Some reports suggest that a relative change in hemoglobin levels ([Delta]Hb) is more predictive of patient outcomes. No such analysis has been done in patients undergoing a KT. Given this, we aimed to analyze the relationship between delayed graft function (DGF), and Hb and [Delta]Hb during KT.

Methods: We conducted a single-center retrospective chart review of all adult, deceased donor KT (2003-2017), excluding those that received a transfusion within the first 24 hours. Hb was captured at various time points within the first 24 hours post-KT. [Delta]Hb was defined as = [(pre-KT Hb – nadir post-KT Hb)/pre-KT Hb] x 100. The outcome of interest was DGF, defined as the need for dialysis within the first week post-KT.

Results: Of the 934 KT, 705 were eligible for analysis. Of these 25% (176) experienced DGF. Several baseline differences were noted in those that experienced DGF. Amongst those recipients that developed DGF, Hb values pre-KT, the lowest Hb post-KT or [Delta]Hb were not statistically different from those that did not develop DGF (Table 1). In a univariate analysis, only pre-KT Hb but not the lowest Hb post-KT or [Delta]Hb were predictive of DGF (Table 2). This effect lost significance in a multivariate analysis.

Conclusion: In those recipients that did not receive a blood transfusion perioperatively, the relative change in hemoglobin post-KT was not predictive of DGF. Future work entails analyzing outcomes in those that received a transfusion. Given the risk of sensitization with blood transfusions, our work supports current restrictive transfusion practices in the KT population.

Table 1: Predictor values of interest by DGF status
In g/L	DGF Median (IQR)	No DGF Median (IQR)	p-value
Pre-transplant Hb	120 (18)	121 (21)	0.10
Nadir Hb	95 (18)	94 (14)	0.89
[Delta]Hb	21 (10)	22 (11)	0.07
p-value calculated by Rank-sum test

Table 2: Odds ratio of DGF, significant values in bold
	Univariate	Multivariate
Pre-transplant Hb	_1.131.68_2.50	_0.981.49_2.27
Nadir Hb	_0.470.74_1.16	_0.500.79_1.28
[Delta]Hb	_0.891.35_2.04	_0.771.21_1.89

CITATION INFORMATION: MacIsaac S., Ramankumar A., Saw C., Naessens V., Cantarovich M., Baran D., Paraskevas S., Tchervenkov J., Chaudhury P., Sandal S. Peri-Operative Hemoglobin, Blood Transfusion and Delayed Graft Function in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

MacIsaac S, Ramankumar A, Saw C, Naessens V, Cantarovich M, Baran D, Paraskevas S, Tchervenkov J, Chaudhury P, Sandal S. Peri-Operative Hemoglobin, Blood Transfusion and Delayed Graft Function in Kidney Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/peri-operative-hemoglobin-blood-transfusion-and-delayed-graft-function-in-kidney-transplant-recipients/. Accessed November 23, 2024.

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