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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

Impact of pre-transplant transfusion on allosensitization. (A) Proportion of patients sensitized stratified by pre-transplant transfusion status. (B) Risk of allosensitization by number of pre-transplant transfusions. *Significant difference as reported in the original publication; †represents sensitization measurement not explicit, but identified according to the text; ‡data reported for 0–5 transfusion vs. > 5 transfusions; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow for comparison between the populations of interest. Therefore, the numbers presented differ from those presented in the primary source publications with the exception of Lim 1992, Direskeneli 1992, and Lietz 2003. CDC: complement-dependent cytotoxicity; ELISA: enzyme-linked immunosorbant assay; FXCM: flow cytometry cross-match; HLA: human leukocyte antigen; Mixed: probable CDC + flow cytometry; MPC: mean peak channel; NR: not reported; PRA: panel reactive antibodies; +ve: positive.
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Figure 2: Impact of pre-transplant transfusion on allosensitization. (A) Proportion of patients sensitized stratified by pre-transplant transfusion status. (B) Risk of allosensitization by number of pre-transplant transfusions. *Significant difference as reported in the original publication; †represents sensitization measurement not explicit, but identified according to the text; ‡data reported for 0–5 transfusion vs. > 5 transfusions; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow for comparison between the populations of interest. Therefore, the numbers presented differ from those presented in the primary source publications with the exception of Lim 1992, Direskeneli 1992, and Lietz 2003. CDC: complement-dependent cytotoxicity; ELISA: enzyme-linked immunosorbant assay; FXCM: flow cytometry cross-match; HLA: human leukocyte antigen; Mixed: probable CDC + flow cytometry; MPC: mean peak channel; NR: not reported; PRA: panel reactive antibodies; +ve: positive.

Mentions: All studies included in the analysis reported a detrimental effect of pre-transplant transfusion on allosensitization (Figure 2): a significant detrimental effect was reported in 6 studies [1,17-21] while a non-significant detrimental effect was reported in the remaining 5 studies [22-26].


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)

Impact of pre-transplant transfusion on allosensitization. (A) Proportion of patients sensitized stratified by pre-transplant transfusion status. (B) Risk of allosensitization by number of pre-transplant transfusions. *Significant difference as reported in the original publication; †represents sensitization measurement not explicit, but identified according to the text; ‡data reported for 0–5 transfusion vs. > 5 transfusions; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow for comparison between the populations of interest. Therefore, the numbers presented differ from those presented in the primary source publications with the exception of Lim 1992, Direskeneli 1992, and Lietz 2003. CDC: complement-dependent cytotoxicity; ELISA: enzyme-linked immunosorbant assay; FXCM: flow cytometry cross-match; HLA: human leukocyte antigen; Mixed: probable CDC + flow cytometry; MPC: mean peak channel; NR: not reported; PRA: panel reactive antibodies; +ve: positive.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Impact of pre-transplant transfusion on allosensitization. (A) Proportion of patients sensitized stratified by pre-transplant transfusion status. (B) Risk of allosensitization by number of pre-transplant transfusions. *Significant difference as reported in the original publication; †represents sensitization measurement not explicit, but identified according to the text; ‡data reported for 0–5 transfusion vs. > 5 transfusions; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow for comparison between the populations of interest. Therefore, the numbers presented differ from those presented in the primary source publications with the exception of Lim 1992, Direskeneli 1992, and Lietz 2003. CDC: complement-dependent cytotoxicity; ELISA: enzyme-linked immunosorbant assay; FXCM: flow cytometry cross-match; HLA: human leukocyte antigen; Mixed: probable CDC + flow cytometry; MPC: mean peak channel; NR: not reported; PRA: panel reactive antibodies; +ve: positive.
Mentions: All studies included in the analysis reported a detrimental effect of pre-transplant transfusion on allosensitization (Figure 2): a significant detrimental effect was reported in 6 studies [1,17-21] while a non-significant detrimental effect was reported in the remaining 5 studies [22-26].

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