Background: Blood transfusions are a well-established risk factor for human leukocyte antigen sensitization in kidney transplant candidates. To date, relatively few studies have explored the effects of perioperative blood transfusions on recipient outcomes after kidney transplantation.

Methods: Patients who underwent kidney transplantation from 1-Jan-2003 to 31-Dec-2012 at the Toronto General Hospital, with follow-up until 31-Dec-2015, were eligible for inclusion in this retrospective cohort study. Exposure to perioperative blood transfusion was defined as, receiving at least one blood transfusion between 2 days pre-operatively to 3 days post-operatively. Study outcomes included biopsy-proven acute rejection, hospital readmission, kidney function, and total graft failure. Linear regression and Cox proportional hazards models were used to examine the independent association between transfusions and the study endpoints.

Results: A total of 1235 patients were included in the study cohort. The incidence of at least one perioperative blood transfusion was 19.8% (244 patients). Perioperative blood transfusions did not independently predict acute rejection (HR 1.13 [95% CI: 0.79, 1.60]; p=0.50) or hospital readmission (HR 0.97 [95% CI: 0.81, 1.17]; p=0.76). Estimated glomerular filtration rate was also not significantly different among transfused vs. non-transfused patients at 3-, 6-, and 12-months post-transplant. Although there was a univariable association between the receipt of perioperative blood transfusions and the risk of total graft failure (HR 1.44 [95% CI 1.09, 1.90]; p=0.01), this relationship was no longer significant after multivariable adjustment (HR 1.27 [95% CI: 0.94, 1.70]; p=0.12).

Conclusion: Perioperative blood transfusions do not portend negative outcomes for kidney transplant recipients in the modern era. Improvements in immunosuppressive therapies and post-transplant medical management may at least partially account for this lack of association.

CITATION INFORMATION: Lineen J, Trac J, Li Y, Famure O, Kim J. Do Perioperative Blood Transfusions Influence Kidney Transplant Outcomes in the Modern Era? Am J Transplant. 2017;17 (suppl 3).

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