학술논문
Challenges in perioperative blood transfusions in kidney transplantation and the need for Patient Blood Management.
Document Type
Academic Journal
Author
Rodríguez-Espinosa D; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Broseta JJ; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Rosario A; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Cacho J; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Tena B; Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain.; Cuadrado-Payan E; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Marrero R; Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain.; Bayés B; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Esforzado N; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Musquera M; Department of Urology, Hospital Clínic of Barcelona, Barcelona, Spain.; Diekmann F; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Cases A; Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain.; Universitat de Barcelona, Barcelona, Spain.; Anemia group of the Spanish Society of Nephrology, Madrid, Spain.; Basora M; Department of Anaesthesia and Perioperative Care, Hospital Clínic of Barcelona, Barcelona, Spain.
Source
Publisher: SIMTI servizi Country of Publication: Italy NLM ID: 101237479 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2385-2070 (Electronic) Linking ISSN: 17232007 NLM ISO Abbreviation: Blood Transfus Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Anemia is highly prevalent in end-stage chronic kidney disease patients, increasing their risk of receiving blood transfusions during and on the days after a kidney transplant (KTx) surgery. However, there is currently a lack of data that thoroughly describes this phenomenon in this population, the associated risk factors, and how they could benefit from the application of Patient Blood Management (PBM) guidelines.
Materials and Methods: Observational study. All adult patients who received a KTx between January 1st , 2020, and December 31 st , 2021, were included and followed up to six months after transplantation. Those who received a multiorgan transplant, whose data was missing in the electronic health records, and who had primary non-function were excluded. We recorded donor and recipient characteristics, cold ischemia time, preoperative hemoglobin concentration, iron status deficiency biomarkers, incidence of delayed graft function and biopsy-proven graft rejections, and graft function at discharge and 6 months after transplantation.
Results: We found that a high amount (39%) of KTx recipients required at least one blood transfusion during the perioperative period. And that 1) most of these patients had anemia at the time of transplantation (85.4%), 2) iron status upon admission was associated with the transfusion of more blood units (3.9 vs 2.7, p=0.019), 3) surgical reintervention (OR 7.28, 2.35-22.54) and deceased donor donation (OR 1.99, 1.24-3.21) were associated with an increased risk of transfusion, and finally, 4) there was an association between a higher number of blood units transfused and impaired kidney graft function six months after hospital discharge (1.6 vs 1.9, p=0.02).
Conclusions: In conclusion, PBM guidelines should be applied to patients on the KTx deceased donor waiting list and especially those scheduled to receive a transplant from a living donor. This could potentially increase the utilization efficiency of blood products and avoid transfusion-related severe adverse effects.
Materials and Methods: Observational study. All adult patients who received a KTx between January 1
Results: We found that a high amount (39%) of KTx recipients required at least one blood transfusion during the perioperative period. And that 1) most of these patients had anemia at the time of transplantation (85.4%), 2) iron status upon admission was associated with the transfusion of more blood units (3.9 vs 2.7, p=0.019), 3) surgical reintervention (OR 7.28, 2.35-22.54) and deceased donor donation (OR 1.99, 1.24-3.21) were associated with an increased risk of transfusion, and finally, 4) there was an association between a higher number of blood units transfused and impaired kidney graft function six months after hospital discharge (1.6 vs 1.9, p=0.02).
Conclusions: In conclusion, PBM guidelines should be applied to patients on the KTx deceased donor waiting list and especially those scheduled to receive a transplant from a living donor. This could potentially increase the utilization efficiency of blood products and avoid transfusion-related severe adverse effects.