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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

Graft survival at 12 months. (A) Difference between transfused and non-transfused patients. (B) Number of pre-transfusions. *Significant difference as reported in the original publication; values have been rounded to the nearest integer, unless < 1. 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 Poli 1995 and Opelz 1997. NR: not reported; n = sample size with reported outcome; CsA: cyclosporin A; DST: donor-specific transfusion.
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Figure 3: Graft survival at 12 months. (A) Difference between transfused and non-transfused patients. (B) Number of pre-transfusions. *Significant difference as reported in the original publication; values have been rounded to the nearest integer, unless < 1. 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 Poli 1995 and Opelz 1997. NR: not reported; n = sample size with reported outcome; CsA: cyclosporin A; DST: donor-specific transfusion.

Mentions: Most studies reported a beneficial effect of pre-transplant transfusion on graft survival at 12 months (Figure 3A): 5 studies reported a significant beneficial effect [25,28-31], and 4 studies a non-significant beneficial effect [1,32-34]. In contrast, a non-significant detrimental effect of pre-transplant transfusions on graft survival was reported in 5 studies [2,35-38]. A possible reason for the conflict between studies is the higher 1-year graft survival in patients without pre-transplant transfusion, typical of current outcomes, compared with older reports. Figure 3B indicates that the beneficial effect of pre-transplant transfusions was observed when graft survival rates in patients without pre-transplant transfusion were low, with the difference in graft survival in patients receiving or not receiving pre-transplant transfusions becoming less apparent as graft outcomes improved over time.


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)

Graft survival at 12 months. (A) Difference between transfused and non-transfused patients. (B) Number of pre-transfusions. *Significant difference as reported in the original publication; values have been rounded to the nearest integer, unless < 1. 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 Poli 1995 and Opelz 1997. NR: not reported; n = sample size with reported outcome; CsA: cyclosporin A; DST: donor-specific transfusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Graft survival at 12 months. (A) Difference between transfused and non-transfused patients. (B) Number of pre-transfusions. *Significant difference as reported in the original publication; values have been rounded to the nearest integer, unless < 1. 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 Poli 1995 and Opelz 1997. NR: not reported; n = sample size with reported outcome; CsA: cyclosporin A; DST: donor-specific transfusion.
Mentions: Most studies reported a beneficial effect of pre-transplant transfusion on graft survival at 12 months (Figure 3A): 5 studies reported a significant beneficial effect [25,28-31], and 4 studies a non-significant beneficial effect [1,32-34]. In contrast, a non-significant detrimental effect of pre-transplant transfusions on graft survival was reported in 5 studies [2,35-38]. A possible reason for the conflict between studies is the higher 1-year graft survival in patients without pre-transplant transfusion, typical of current outcomes, compared with older reports. Figure 3B indicates that the beneficial effect of pre-transplant transfusions was observed when graft survival rates in patients without pre-transplant transfusion were low, with the difference in graft survival in patients receiving or not receiving pre-transplant transfusions becoming less apparent as graft outcomes improved over time.

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