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An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival.

Scornik JC, Bromberg JS, Norman DJ, Bhanderi M, Gitlin M, Petersen J - BMC Nephrol (2013)

Bottom Line: Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates.Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice.Results of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, College of Medicine, University of Florida, Gainesville, FL, USA. scornik@pathology.ufl.edu.

ABSTRACT

Background: Blood transfusions have the potential to improve graft survival, induce sensitization, and transmit infections. Current clinical practice is to minimize transfusions in renal transplantation candidates, but it is unclear if the evidence continues to support pre-transplant transfusion avoidance. Changes in the Medicare prospective payment system may increase transfusion rates. Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates.

Methods: A review applying a systematic approach and conducted using MEDLINE(®), Embase(®), and the Cochrane Library for English-language publications (timeframe: 01/1984-03/2011) captured 180 studies and data from publically available registries and assessed the impact of transfusions on allosensitization and graft survival, and the impact of allosensitization on graft survival and wait time.

Results: Blood transfusions continued to be a major cause of allosensitization, with allosensitization associated with increased rejection and graft loss, and longer wait times to transplantation. Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice. Recent data suggested that it may be the donor-specific antibody component of allosensitization that carried the risk to graft outcomes.

Conclusions: Results of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

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Related in: MedlinePlus

PRISMA diagram depicting study flow through the review. *The number of studies does not sum to 180 across all objectives since a study may answer more than one objective. †The number of studies for each figure does not sum to the number of studies summarized since a study may be presented in different figures or multiple parts of a single figure. Not peer-reviewed: studies published in non-peer-reviewed journals (specifically Clinical Transplants and Transplantation Proceedings). Comparison not of interest: includes comparing various types or volume of transfusion (e.g. donor specific versus random); Outcome reporting: data for the outcome have not been reported in a format suitable for graphical representation (e.g. outcomes reported for one patient group only, outcome was drawn from a general conclusion in the text, time points were different from those selected for extraction [3, 6, 12, 24, 36, 60, 120, and 360 months], or outcomes were impacted by the different antibody detection techniques used in the study).
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Figure 1: PRISMA diagram depicting study flow through the review. *The number of studies does not sum to 180 across all objectives since a study may answer more than one objective. †The number of studies for each figure does not sum to the number of studies summarized since a study may be presented in different figures or multiple parts of a single figure. Not peer-reviewed: studies published in non-peer-reviewed journals (specifically Clinical Transplants and Transplantation Proceedings). Comparison not of interest: includes comparing various types or volume of transfusion (e.g. donor specific versus random); Outcome reporting: data for the outcome have not been reported in a format suitable for graphical representation (e.g. outcomes reported for one patient group only, outcome was drawn from a general conclusion in the text, time points were different from those selected for extraction [3, 6, 12, 24, 36, 60, 120, and 360 months], or outcomes were impacted by the different antibody detection techniques used in the study).

Mentions: A total of 7494 citations were identified, of which 206 citations relating to 180 studies were relevant to the objectives. Of these, 62 studies were summarized (Figure 1). The Downs and Black [10] quality score for these studies ranged from 13 to 22 out of a possible score of 26. Although there is no definitive cut-off for an acceptable score, a recent publication on evidence assessment considered > 14 as acceptable [11]. Using this criteria, majority of the studies were considered to be of acceptable quality, and only 6 were considered to be of poor quality [1,12-16].


An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival.

Scornik JC, Bromberg JS, Norman DJ, Bhanderi M, Gitlin M, Petersen J - BMC Nephrol (2013)

PRISMA diagram depicting study flow through the review. *The number of studies does not sum to 180 across all objectives since a study may answer more than one objective. †The number of studies for each figure does not sum to the number of studies summarized since a study may be presented in different figures or multiple parts of a single figure. Not peer-reviewed: studies published in non-peer-reviewed journals (specifically Clinical Transplants and Transplantation Proceedings). Comparison not of interest: includes comparing various types or volume of transfusion (e.g. donor specific versus random); Outcome reporting: data for the outcome have not been reported in a format suitable for graphical representation (e.g. outcomes reported for one patient group only, outcome was drawn from a general conclusion in the text, time points were different from those selected for extraction [3, 6, 12, 24, 36, 60, 120, and 360 months], or outcomes were impacted by the different antibody detection techniques used in the study).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125965&req=5

Figure 1: PRISMA diagram depicting study flow through the review. *The number of studies does not sum to 180 across all objectives since a study may answer more than one objective. †The number of studies for each figure does not sum to the number of studies summarized since a study may be presented in different figures or multiple parts of a single figure. Not peer-reviewed: studies published in non-peer-reviewed journals (specifically Clinical Transplants and Transplantation Proceedings). Comparison not of interest: includes comparing various types or volume of transfusion (e.g. donor specific versus random); Outcome reporting: data for the outcome have not been reported in a format suitable for graphical representation (e.g. outcomes reported for one patient group only, outcome was drawn from a general conclusion in the text, time points were different from those selected for extraction [3, 6, 12, 24, 36, 60, 120, and 360 months], or outcomes were impacted by the different antibody detection techniques used in the study).
Mentions: A total of 7494 citations were identified, of which 206 citations relating to 180 studies were relevant to the objectives. Of these, 62 studies were summarized (Figure 1). The Downs and Black [10] quality score for these studies ranged from 13 to 22 out of a possible score of 26. Although there is no definitive cut-off for an acceptable score, a recent publication on evidence assessment considered > 14 as acceptable [11]. Using this criteria, majority of the studies were considered to be of acceptable quality, and only 6 were considered to be of poor quality [1,12-16].

Bottom Line: Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates.Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice.Results of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, College of Medicine, University of Florida, Gainesville, FL, USA. scornik@pathology.ufl.edu.

ABSTRACT

Background: Blood transfusions have the potential to improve graft survival, induce sensitization, and transmit infections. Current clinical practice is to minimize transfusions in renal transplantation candidates, but it is unclear if the evidence continues to support pre-transplant transfusion avoidance. Changes in the Medicare prospective payment system may increase transfusion rates. Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates.

Methods: A review applying a systematic approach and conducted using MEDLINE(®), Embase(®), and the Cochrane Library for English-language publications (timeframe: 01/1984-03/2011) captured 180 studies and data from publically available registries and assessed the impact of transfusions on allosensitization and graft survival, and the impact of allosensitization on graft survival and wait time.

Results: Blood transfusions continued to be a major cause of allosensitization, with allosensitization associated with increased rejection and graft loss, and longer wait times to transplantation. Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice. Recent data suggested that it may be the donor-specific antibody component of allosensitization that carried the risk to graft outcomes.

Conclusions: Results of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

Show MeSH
Related in: MedlinePlus