Sensitization from transfusion in patients awaiting primary kidney transplant

Yabu, Julie M.; Anderson, Matthew W.; Kim, Deborah; Bradbury, Brian D.; Lou, Calvin D.; Petersen, Jeffrey; Rossert, Jérôme; Chertow, Glenn M.; Tyan, Dolly B.

doi:10.1093/ndt/gft362

Cited by 69 publications

(55 citation statements)

References 36 publications

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“…This result is in keeping with a previous study suggesting that blood transfusions in CKD are associated with a 28% decrease in the odds of transplant [18]. Our finding may reflect elevations in panel reactive antibody levels in pretransplant patients who receive blood transfusions [19,20], although we cannot exclude the possibility that it simply reflects a better underlying clinical profile for patients who do not receive transfusions.…”

Section: Discussionsupporting

confidence: 92%

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

et al. 2014

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Background/Aims: Predialysis care has been associated with improved first-year outcomes. We investigated types of predialysis care associated with improved patient outcomes in patients initiating dialysis with a fistula and at least 2 years of predialysis care. Methods: In this retrospective cohort of incident hemodialysis patients with ≥2 years of Medicare coverage before dialysis initiation, care patterns and patients were determined using Medicare claims. Fistula use at initiation was ascertained from the Medical Evidence Report. Results: Patients aged ≥67 years who initiated hemodialysis with a fistula (n = 14,459) differed demographically and clinically from patients who initiated with other vascular access types; however, 55% had diabetes, 28% heart failure, and 40% ischemic heart disease. In the year preceding initiation, 88% of these patients visited a nephrologist, 66% a cardiologist, 9% an endocrinologist, and 3% a dietician; most underwent routine laboratory measurements. In the first year of dialysis, 50% were hospitalized and 1.3% underwent transplant; the mortality rate remained constant (∼20 per 100 patient-years). Of predialysis care factors evaluated, only fistula placement more than 1 month before dialysis initiation was associated with lower hospitalization and mortality risk and greater likelihood of transplant. Other potentially modifiable factors included more contact with cardiologists and endocrinologists. Conclusion: Patients initiating dialysis with a functioning fistula appear to receive substantial predialysis preparation. This selected population does not show the excess mortality risk often observed early in dialysis treatment. Earlier fistula placement and referral to cardiology and endocrinology appear to be important aspects of predialysis care.

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Section: Discussionsupporting

confidence: 92%

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

et al. 2014

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“…It is very unlikely that undocumented pregnancy‐induced alloimmunization affected our results as most females studied were premenarchal, older patient age was not associated with alloimmunization and males actually had a higher prevalence of HLA antibodies. Our findings add to the growing body of evidence that HLA alloimmunization after RBC transfusion remains a problem despite leucocyte reduction (Balasubramaniam et al , ; Yabu et al , ). The source of the HLA class I antigens in RBC units causing sensitization is currently unknown.…”

Section: Discussionsupporting

confidence: 75%

Red blood cell transfusions are associated with HLA class I but not H‐Y alloantibodies in children with sickle cell disease

et al. 2015

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Blood transfusions can induce alloantibodies to antigens on red blood cells (RBCs), white blood cells and platelets, with these alloantibodies affecting transfusion and transplantation. While transfusion-related alloimmunization against RBC antigens and human leucocyte antigens (HLA) have been studied, transfusion-related alloimmunization to minor histocompatibility antigens (mHA), such as H-Y antigens, has not been clinically characterized. We conducted a cross-sectional study of 114 children with sickle cell disease (SCD) and tested for antibodies to 5 H-Y antigens and to HLA class I and class II. Few patients had H-Y antibodies, with no significant differences in the prevalence of any H-Y antibody observed among transfused females (7%), transfused males (6%) and never transfused females (4%). In contrast, HLA class I, but not HLA class II, antibodies were more prevalent among transfused than never transfused patients (class I: 33% vs. 13%, p=0.046; class II: 7% vs. 8%, p=0.67). Among transfused patients, RBC alloantibody history but not amount of transfusion exposure was associated with a high (>25%) HLA class I panel reactive antibody) (Odds ratio 6.8, 95% confidence interval 2.1–22.3). These results are consistent with immunological responder and non-responder phenotypes, wherein a subset of patients with SCD may be at higher risk for transfusion-related alloimmunization.

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“…This has important implications. Recent evidence has shown that RBC transfusion can cause allosensitization [23,24] , such that the increased use of transfusions could possibly result in increased sensitization in the dialysis population overall [23,25,26] . This is important because sensitized kidney transplant candidates wait longer and their graft survival is shorter should they undergo transplant [27] .…”

Section: Discussionmentioning

confidence: 99%

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

Wetmore¹,

Peng²,

Monda³

et al. 2015

Am J Nephrol

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Background/Aims: Recent changes in clinical practice guidelines and reimbursement policies may have affected the use of anemia-related medications and red blood cell (RBC) transfusions in peritoneal dialysis (PD) and hemodialysis (HD) patients. We sought to compare patterns of erythropoiesis-stimulating agents (ESA) and intravenous (IV) iron use, achieved hemoglobin levels, and RBC transfusion use in PD and HD patients. Methods: In quarterly cohorts of prevalent dialysis patients receiving persistent therapy (>3 months), 2007-2011, with Medicare Parts A and B coverage, we assessed ESA and IV iron use and dose, RBC transfusions, and hemoglobin levels. Quarterly transfusion rates were calculated. Results: Observable PD and HD patients numbered 14,958 and 221,866 in Q1/2007 and 17,842 and 256,942 in Q4/2011. Adjusted ESA use was lower in PD (71.4-80.1%) than in HD (86.9-92.0%) patients, decreasing from 80.1% (Q1/2010) to 71.4% (Q4/2011) in PD patients, and from 92.0 to 86.9% in HD patients. The mean adjusted ESA dose decreased by 67.5% in PD and 58.4% in HD patients. IV iron use tended to increase, peaking at 39.3% for PD (Q3/2011) and 80.5% for HD (Q2/2011) patients. Adjusted mean hemoglobin levels fell from 11.7 to 10.6 mg/dl in PD and from 12.0 to 10.7 mg/dl in HD ESA users; adjusted transfusion rates increased from 2.4 to 3.0 per 100 patient-months in PD and from 2.6 to 3.3 in HD patients. Conclusions: In patients receiving persistent dialysis, dose and frequency of ESA administrations decreased during the period 2007-2011. Mean hemoglobin levels decreased by more than 1 g/dl, while transfusion rates increased by approximately 25%.

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Sensitization from transfusion in patients awaiting primary kidney transplant

Abstract: Among prospective primary kidney transplant recipients, RBC transfusion results in clinically significant increases in HLA antibody strength and breadth, which adversely affect the opportunity for future transplant.

Cited by 69 publications

References 36 publications

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

Red blood cell transfusions are associated with HLA class I but not H‐Y alloantibodies in children with sickle cell disease

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

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