Background: Preoperative anemia can contribute to poor outcomes in transfusion-free (TF) kidney transplants (KT). There are no established guidelines on the acceptable degree of anemia. We present outcomes for a large number of TF patients.

Objective: To compare clinical outcomes of TF- KT patients to anemic transfusion accepting (ATA) patients in both deceased and living donor KT in terms of transfusion requirement, graft function, and overall mortality.

Methods: A retrospective analysis of TF and ATA from a single institution was performed. TF patients were compared to patients with preoperative anemia (hemoglobin < 10 gm/dL). Hemoglobin and creatinine (Cr) examined preoperatively and POD#1, 5, and 30. The incidence of intraoperative and postoperative transfusion in ATA were analyzed using mean and 95% CI. Statistical analyses were performed using SPSS v.24; p = 0.05.

Results: In regards to TF, there were 32 KT from 1999-2017, of which n=11 were living and n=21 were deceased donor. 22 patients were male (69%) with mean age 48 years (range 25-69). Mean preoperative hgb was 11.8 g/dL (range 8.6-14), including 3 patients with a starting Hg <10 g/dL (8.6-9.8). Two patients underwent re-operation, including one for hematoma evacuation. Delayed graft function (DGF) occurred in 10 recipients. There were 4 deaths, one of which was related to inability to transfuse blood postoperatively.

In regards to ATA, there were 90 KT with preoperative Hb <10 g/dL from 2011-2017. 51 patients were male (57%) with a mean age of 51.1 years (range 21 -77). Mean Hgb was 9.2 g/dL, (range 7.6 to 9.9). Transfusion incidence was 10% (n=9) preoperatively and 42% (n=38) postoperatively, including 6 patients who required both intra-and post-operative transfusions. Total incidence was 46% (n=41). There were four patients requiring reoperation and no patient deaths in this group. Mean Hgb was 9.05 g/dL for patients who required transfusion and 9.36 g/dL for those who did not. Comparison of the mean pre-operative HGB between these groups did not show any statistical differences.

Conclusions: Transfusion requirements in KT patients with a preoperative Hb <10 g/dL may be associated with poor clinical outcomes. While not prohibitory, careful patient selection and optimization should be warranted in TF patients undergoing KT.

CITATION INFORMATION: Kaur N., Pita A., Lane C., Bhatnagar M., Matsuoka L., Selby R., Dhanireddy K. Preoperative Anemia in Transfusion Free Patients Undergoing Kidney Transplant May Be Associated with Poor Outcome Am J Transplant. 2017;17 (suppl 3).

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