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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 allosensitization on graft rejection following kidney transplantation measured by acute rejection, chronic rejection, and antibody-mediated rejection. *Significant difference as reported in the original publication; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow comparison of populations of interest. Therefore, the numbers differ from the primary publications with the exception of Mai 2009, Eng 2008, Pratico-Barbato 2008, Wang 2006, Le Bas-Bernardet 2003, Karpinski 2001, Scornik 2001, Hanish 2010, Riethmuller 2010, Cinti 2009, and Vlad 2009. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; PRA: panel reactive antibodies; +ve: positive.
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Figure 4: Impact of allosensitization on graft rejection following kidney transplantation measured by acute rejection, chronic rejection, and antibody-mediated rejection. *Significant difference as reported in the original publication; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow comparison of populations of interest. Therefore, the numbers differ from the primary publications with the exception of Mai 2009, Eng 2008, Pratico-Barbato 2008, Wang 2006, Le Bas-Bernardet 2003, Karpinski 2001, Scornik 2001, Hanish 2010, Riethmuller 2010, Cinti 2009, and Vlad 2009. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; PRA: panel reactive antibodies; +ve: positive.

Mentions: Most studies reported a detrimental effect of allosensitization on graft rejection: 9 studies reported a significant detrimental effect [13,14,39-45], and 7 studies reported a non-significant detrimental effect [12,15,16,46-49] (Figure 4). In contrast, 6 studies reported a non-detrimental effect of allosensitization on graft rejection [50-55]. Of these, 2 restricted the analysis to B cell antibodies [51,54].


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 allosensitization on graft rejection following kidney transplantation measured by acute rejection, chronic rejection, and antibody-mediated rejection. *Significant difference as reported in the original publication; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow comparison of populations of interest. Therefore, the numbers differ from the primary publications with the exception of Mai 2009, Eng 2008, Pratico-Barbato 2008, Wang 2006, Le Bas-Bernardet 2003, Karpinski 2001, Scornik 2001, Hanish 2010, Riethmuller 2010, Cinti 2009, and Vlad 2009. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; 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 4: Impact of allosensitization on graft rejection following kidney transplantation measured by acute rejection, chronic rejection, and antibody-mediated rejection. *Significant difference as reported in the original publication; values have been rounded to the nearest integer. NOTE: Additional calculation has been performed to allow comparison of populations of interest. Therefore, the numbers differ from the primary publications with the exception of Mai 2009, Eng 2008, Pratico-Barbato 2008, Wang 2006, Le Bas-Bernardet 2003, Karpinski 2001, Scornik 2001, Hanish 2010, Riethmuller 2010, Cinti 2009, and Vlad 2009. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; PRA: panel reactive antibodies; +ve: positive.
Mentions: Most studies reported a detrimental effect of allosensitization on graft rejection: 9 studies reported a significant detrimental effect [13,14,39-45], and 7 studies reported a non-significant detrimental effect [12,15,16,46-49] (Figure 4). In contrast, 6 studies reported a non-detrimental effect of allosensitization on graft rejection [50-55]. Of these, 2 restricted the analysis to B cell antibodies [51,54].

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