Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Abstract

ImportanceRed blood cell transfusion (RBCT) is frequently required in the early post–kidney transplant period, but long-term outcomes associated with RBCT is controversial. Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes.ObjectiveTo study the association between RBC storage duration and transplant outcomes.Design, Setting, and ParticipantsThis was a nationwide retrospective cohort study based on data linking between 2 prospective French nationwide registries. Clinical transplant parameters, outcomes, and RBCT characteristics were extracted from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. All 12 559 patients having received a first kidney transplant in France between January 1, 2002, and December 31, 2008, were included. Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022.ExposuresClinical outcomes of transplant recipients who underwent early RBCT were analyzed considering transfusion characteristics.Main Outcomes and MeasuresCox proportional hazards regression models were fitted to evaluate transplant failure defined as graft loss or death with a functional graft.ResultsAmong 12 559 patients who underwent kidney transplant, 3483 received an RBCT during the first 14 days posttransplant. The median (IQR) age of patients was 53.0 (41.5-61.2) years, and 1929 patients (55.4%) were male. Median (IQR) follow-up was 7.8 (7.6-8.0) years. In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in risk of transplant failure (hazard ratio, 0.99; 95% CI, 0.98-1.00 for each additional storage day; P = .06). Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days.Conclusions and RelevanceIn this study, longer RBC storage duration was associated with a decreased risk of transplant failure among patients who received kidney transplants and RBC transfusions. Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion.

Abdominal Organ Transplantation: Noteworthy Literature in 2023

“…The authors hypothesized that immunomodulation in RBCs stored for longer time periods involving changes in major histocompatibility complex molecule expression, decreases in pro-inflammatory cytokines, and leukocyte depletion may play a role in promoting graft survival. 6…”

Error in Results

“…The Original Investigation titled “Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion,” 1 published on September 14, 2023, was corrected to fix typographical errors in the sensitivity analyses in the Results. The article reported that “patients who received transfusions the same day as the transplant procedure had a 1.7% absolute decrease in transplant survival at 1 year.” This has been corrected to “1.7% absolute increase.” It was also reported that “patients who received transfusions on the day of transplant with RBC stored for 20 days or more had 85% higher transplant survival at 5 years.” The correct percentage is 8.5%.…”