Prospective Evaluation of Pretransplant Blood Transfusions in Cadaver Kidney Recipients

Opelz, Gerhard; Vanrenterghem, Yves; Kirste, G.; Gray, Derek W. R.; Horsburgh, T.; Lachance, Jean-Guy; Largiadèr, F; Lange, H.; Vujaklija-Stipanović, Ksenija; Alvarez-Grande, J; Schott, W.; Hoyer, J.; Schnuelle, Peter; Descoeudres, C; Ruder, H.; Wujciak, T.; Schwarz, V.

doi:10.1097/00007890-199704150-00010

Cited by 234 publications

(115 citation statements)

References 10 publications

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“…Proposed mechanisms for this immunosuppressive effect include the induction of suppressor T cells and antiidiotypic antibodies, deletion of naive T cells, and decreased natural killer cell activity. [23][24][25][26][27][28][29] Previous investigators have observed that, in adult populations that have undergone cardiovascular or colorectal surgery, the risk of surgical site infection increases 7%-14% with each unit of packed red blood cells transfused. [23][24][25][26][27][28][29] Transfusion may also be a marker for frequent access of arterial catheters and CVCs.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Elward

Fraser

2006

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Elward

Fraser

2006

Infect. Control Hosp. Epidemiol.

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“…To re-examine the transfusion effect, Opelz et al performed the first randomized clinical trial of pretransplant blood transfusions on graft outcomes. A total of 423 prospective cadaveric kidney transplant recipients from 14 European centers were randomly assigned to receive three pretransplant packed cell transfusions (n=205) or transplants without transfusions (n=218) (19). The graft survival rate was significantly higher in the transfusion recipients than in patients who did not receive transfusions (at 1 year: 90%62% versus 82%63%, P=0.02; at 5 years: 79%63% versus 70%64%, P=0.03).…”

Section: Overview Of Blood Transfusion Use In Patients With Ckdmentioning

confidence: 99%

Effect of Red Cell Transfusions on Future Kidney Transplantation

Obrador

Macdougall

2013

Clinical Journal of the American Society of Nephrology

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SummaryRed cell transfusions, erythropoiesis-stimulating agents (ESAs), and intravenous iron therapy all have a place in the treatment of anemia associated with CKD. Their relative merits and uses are subject to many clinical and nonclinical factors. New concerns associated with the use of ESA therapy make it likely that the use of blood transfusions will increase, refueling previous debates about their associated risks. Data on whether red cell transfusions increase sensitization to HLA antigens, rendering subsequent transplantation more problematic, are mainly derived from older literature. Older data suggested that women were more at risk of HLA sensitization than men, particularly those with previous multiple pregnancies, although recent U.S. Renal Data System data have challenged this. HLA sensitization prolongs the waiting time for transplantation and reduces graft survival. Leukocyte depletion of red cells does not appear to reduce the risk of HLA sensitization. This review summarizes much of the data on these issues, as well as highlighting the need for further research on the potential risks for blood transfusion in patients with CKD.

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“…Allogeneic blood transfusion has been demonstrated to promote tumour growth in experimental animals. 8,9 Renal allograft survival was better in patients receiving allogeneic blood transfusion prior to transplant 3,10 which is consistent with a reduction in immune function. The risk of recurrent cancer has not been demonstrated in randomized control trials.…”

mentioning

confidence: 80%

“…Il y a une perte concomitante de globules rouges de 4 à 19 % associée à la filtra-tion. 2,3 Pendant la conservation, les globules blancs produisent des cytokines, lesquelles sont impliquées dans la communication intracellulaire et influencent le développement et le maintien de l'immunité et du processus inflammatoire. Théoriquement, ces cytokines peuvent nuire à la fonction immunitaire, 4-7 la réduction leucocytaire préconservation pourrait donc être supérieure à celle de la postconservation, quoique les essais cliniques n'aient pas confirmé cette hypothèse.…”

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Will we ever know if leukoreduction of red blood cells should be performed?

Carson

Berlin

2004

Can J Anesth/J Can Anesth

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N this month's Journal, Fergusson and colleagues describe a meta-analysis of clinical trials that evaluated the efficacy of leukoreduction of red blood cell (RBC) transfusion. 1 The authors found that when all patients in the randomized trials were included in the meta-analysis, statistically significant benefits were not demonstrated. However, if only patients that actually received a transfusion were included in the analysis, a 40% reduction in postoperative infections was demonstrated. This report raises a number of questions. These include: 1) Do the results presented in this report add convincing evidence that leads to the conclusion that leukoreduction improves clinical outcomes? 2) Is it methodologically proper to include only patients who received transfusion in the analysis? We begin this commentary with some background information on leukoreduction and its rationale.Universal leukoreduction is performed in Canada and many European countries. It remains voluntary in the United States. Leukoreduction involves the removal of white blood cells by use of filtration and may be performed either at the time of the preparation of RBC (prestorage) or concurrent with administration of (poststorage) RBC. There is a concomitant loss of red cells from 4 to 19% associated with filtration. 2,3 During blood storage, white blood cells produce cytokines, which are involved with intracellular communication and influence development and maintenance of immunity and the inflammatory processes. Because these cytokines may interfere with immune function, 4-7 in theory, prestorage should be superior to poststorage leukoreduction, although this has not been confirmed in clinical trials.Allogeneic transfusion has been thought to alter immune function for many years. Allogeneic blood transfusion has been demonstrated to promote tumour growth in experimental animals. 8,9 Renal allograft survival was better in patients receiving allogeneic blood transfusion prior to transplant 3,10 which is consistent with a reduction in immune function. The risk of recurrent cancer has not been demonstrated in randomized control trials. 11 However, it remains very controversial whether allogeneic blood transfusion increases the risk of bacterial infection.Ten randomized clinical trials have evaluated the effects of leukoreduction. 1 Scanning the results of clinical trials displayed in the table and figures in the article by Fergusson et al. reveals significant heterogeneity in the design and results of the studies. The majority of studies were performed in patients undergoing colorectal or cardiac surgery and used prestorage leukodepletion. Buffy-coated depleted blood was the standard RBC preparation used in many studies, which may make it more difficult to demonstrate a difference, since about 75% of leukocytes are removed by this process. Most of the individual studies did not demonstrate an improvement in outcome. In two of the three studies that showed differences, the observed effects were much larger than seems biologically plausible. 12,13 O...

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Prospective Evaluation of Pretransplant Blood Transfusions in Cadaver Kidney Recipients

Cited by 234 publications

References 10 publications

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Effect of Red Cell Transfusions on Future Kidney Transplantation

Will we ever know if leukoreduction of red blood cells should be performed?

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