Thread: Hello. Wonder if the problem is the blood transfusions

I have a friend who had a kidney transplate a year ago this month. Blood transfusion was used during surgery and he has had several transfusions since. He's going to have more transfusions and the doctor says that he will more than likely have to going back on dialisis with the new kidney. I feel like his physical and mental state has gone down, and wonder if the problem is the blood transfusions. I'd apprciate any response.

It is a difficult and complex question.


Consider following article:


Clin Transplant. 2012 Mar 12. doi: 10.1111/j.1399-0012.2012.01598.x. [Epub ahead of print]
Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients.

Molnar MZ, Kovesdy CP, Rosivall L, Bunnapradist S, Hoshino J, Streja E, Krishnan M, Kalantar-Zadeh K.
Source

Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.

Abstract

BACKGROUND:

Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantationperiod. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF.
METHODS:

Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF.
RESULTS:

Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34).
CONCLUSIONS:

Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.
Associations of pre-transplant anemia manage... [Clin Transplant. 2012] - PubMed - NCBI

Transplantation. 2012 Feb 27;93(4):418-22.
Allosensitization rate of male patients awaiting first kidney grafts after leuko-depleted blood transfusion.

Balasubramaniam GS, Morris M, Gupta A, Mesa IR, Thuraisingham R, Ashman N.
Source

Department of Nephrology and Transplantation, MRC Centre for Transplantation, Guy's and St. Thomas' Hospital, Great Maze Pond, Southwark, London, United Kingdom. gowrie@doctors.net.uk

Abstract

BACKGROUND:

Blood transfusions are generally avoided for potential renal transplant recipients due to risk of human leukocyte antigen (HLA) allosensitization. Despite the near universal use of erythropoiesis-stimulating agents, there are still occasions when patients require blood transfusions for reasons such as resistance to erythropoiesis-stimulating agents or cardiovascular instability. The risk of allosensitization in renal patients is believed to be lower with leuko-depleted blood. We sought to quantify the risk of blood transfusion per se in male renal patients on the transplant waiting list for their first kidneygraft, using sensitive solid phase antibody detection.
METHOD:

Cross-sectional survey looking at the prevalence of HLA antibody detected using single antigen Luminex beads in male patients awaiting first renal transplantation.
RESULTS:

One hundred sixteen male patients awaiting their first kidney transplant were identified on our waiting list. Seven of the 42 patients (16.7%) who received at least one unit of leuko-depleted blood developed HLA antibody (HLAab). Of the remaining 74 patients without a history of transfusion, 3 (4.1%) were found to have HLAab. All the antibodies identified were directed against class I antigens. A history of blood transfusion gave a relative risk of 4.1 of developing HLAab (P=0.02).
CONCLUSION:

Male patients awaiting their first organ transplant had a fourfold increased risk of developing HLA antibody if they had been previously transfused when compared with those who did not have a history of a transfusion. Transfusion even in the postleukodepletion era continues to pose a significant risk of sensitization.
Allosensitization rate of male patients awai... [Transplantation. 2012] - PubMed - NCBI