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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 donor specific antibodies on graft rejection and survival. (A) Graft rejection. (B) Graft survival. *Significant difference as reported in the original publication; †death censored graft survival reported; 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 for Domingues 2010, Van 2008, Gupta 2008, and Lefaucheur 2010. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; -ve: negative; +ve: positive.
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Figure 6: Impact of donor specific antibodies on graft rejection and survival. (A) Graft rejection. (B) Graft survival. *Significant difference as reported in the original publication; †death censored graft survival reported; 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 for Domingues 2010, Van 2008, Gupta 2008, and Lefaucheur 2010. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; -ve: negative; +ve: positive.

Mentions: Considering the impact of DSAs, 8 of the 9 studies reported that the presence of DSAs was associated with more acute graft rejections [14,50,52,66-71], with 2 studies reporting significant differences between groups [67,71] (Figure 6A). In addition, DSAs were associated with lower graft survival in 5 out of 6 studies investigating this relationship [47,50,52,57,71], with 2 studies reporting significant differences between groups [71,72] (Figure 6B). In contrast, no differences were observed in 3 studies, either with acute rejection [50] or graft survival [41,66].


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 donor specific antibodies on graft rejection and survival. (A) Graft rejection. (B) Graft survival. *Significant difference as reported in the original publication; †death censored graft survival reported; 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 for Domingues 2010, Van 2008, Gupta 2008, and Lefaucheur 2010. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; -ve: negative; +ve: positive.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Impact of donor specific antibodies on graft rejection and survival. (A) Graft rejection. (B) Graft survival. *Significant difference as reported in the original publication; †death censored graft survival reported; 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 for Domingues 2010, Van 2008, Gupta 2008, and Lefaucheur 2010. CDC: complement-dependent cytotoxicity; CDC-XM: complement-dependent cytotoxicity cross-match; FCXM: flow cytometry cross-match; NR: not reported; -ve: negative; +ve: positive.
Mentions: Considering the impact of DSAs, 8 of the 9 studies reported that the presence of DSAs was associated with more acute graft rejections [14,50,52,66-71], with 2 studies reporting significant differences between groups [67,71] (Figure 6A). In addition, DSAs were associated with lower graft survival in 5 out of 6 studies investigating this relationship [47,50,52,57,71], with 2 studies reporting significant differences between groups [71,72] (Figure 6B). In contrast, no differences were observed in 3 studies, either with acute rejection [50] or graft survival [41,66].

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