Advertisement

Prevalence and predictors of blood transfusion after pediatric kidney transplantation

  • Katherine M. Richards
  • Rebecca A. Spicer
  • Elizabeth Craig
  • Sean E. Kennedy
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation

Abstract

Background

Blood transfusion after kidney transplant carries a risk of sensitization to the graft as well as blood borne infections.

The aim of this study was to describe the prevalence of blood transfusions in pediatric recipients of kidney transplants and to determine the factors associated with transfusions during the perioperative period. Additionally, to describe the changes in hemoglobin levels during the first 12 months following transplant.

Method

A retrospective, single center analysis using data collected prospectively between 2010 and 2017. Red blood cell transfusion within the first week after transplant and anemia at 3 months were used as outcomes. Multivariate analysis was performed on significant variates with results described according to odds ratio (OR) and interquartile range (IQR).

Results

Transfusions were given after 21 of 42 (50%) transplants in recipients aged between 1 and 17 years (median 14 years). Age, height, weight, and pre-transplant hemoglobin predicted transfusion in univariate analyses. Regression analysis identified pre-transplant hemoglobin as an independent factor (OR 0.85, IQR 0.73–0.98; p = 0.02). Anemia was present at 3 months after 15 (36%) transplants. Anemia at 3 months was associated with older and larger recipients, lower pre-transplant hemoglobin, and lower estimated glomerular filtration rate (eGFR) on univariate analysis. Logistic regression analysis identified eGFR at 3 months as the only independent predictor of anemia at 3 months (OR 0.93, IQR 0.87–0.99; p = 0.04).

Conclusions

Transfusions are prevalent in the perioperative period after pediatric kidney transplantation. Lower pre-transplant hemoglobin increases the risk of transfusion. Graft function predicts hemoglobin levels at 3 months.

Keywords

Kidney transplantation Child Blood transfusion Anemia Erythropoietin Risk factors 

Notes

Compliance with ethical standards

The study had approval from the local human research ethics committee.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Kausman JY, Powell HR, Jones CL (2004) Anemia in pediatric renal transplant recipients. Pediatr Nephrol 19:526–530CrossRefPubMedGoogle Scholar
  2. 2.
    Yorgin PD, Belson A, Sanchez J, Al Uzri AY, Sarwal M, Bloch DA, Oehlert J, Salvatierra O, Alexander SR (2002) Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients. Am J Kidney Dis 40:1306CrossRefPubMedGoogle Scholar
  3. 3.
    Galutira PJ, Del Rio M (2012) Understanding renal posttransplantation anemia in the pediatric population. Pediatr Nephrol 27:1079–1085CrossRefPubMedGoogle Scholar
  4. 4.
    Kamar N, Rostaing L, Ignace S, Villar E (2012) Impact of post-transplant anemia on patient and graft survival rates after kidney transplantation: a meta-analysis. Clin Transpl 26:461–469CrossRefGoogle Scholar
  5. 5.
    Verghese P, Gillingham K, Matas A, Chinnakotla S, Chavers B (2016) Post-transplant blood transfusions and pediatric renal allograft outcomes. Pediatr Transplant 20:939–945CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rees L, Kim JJ (2015) HLA sensitisation: can it be prevented? Pediatr Nephrol 30:577–587CrossRefPubMedGoogle Scholar
  7. 7.
    Faravardeh A, Eickhoff M, Jackson S, Issa N, Dunn T, Matas A, Ibrahim H (2013) Frequency of blood transfusion episodes after kidney transplantation is associated with development of class II donor specific antibodies. Am J Transplant 13:194Google Scholar
  8. 8.
    Ferrandiz I, Congy-Jolivet N, Del Bello A, Debiol B, Trébern-Launay K, Esposito L, Milongo D, Dörr G, Rostaing L, Kamar N (2016) Impact of early blood transfusion after kidney transplantation on the incidence of donor-specific anti-HLA antibodies. Am J Transplant 16:2661–2669CrossRefPubMedGoogle Scholar
  9. 9.
    Klein HG, Spahn DR, Carson JL (2007) Red blood cell transfusion in clinical practice. Lancet 370:415–426CrossRefPubMedGoogle Scholar
  10. 10.
    Kidney disease: Improving global outcomes (KDIGO) anemia work group (2012) KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl:279–335Google Scholar
  11. 11.
    Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, Pellegrini F, Ravani P, Jardine M, Perkovic V, Graziano G, McGee R, Nicolucci A, Tognoni G, Strippoli GF (2010) Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med 153:23–33CrossRefPubMedGoogle Scholar
  12. 12.
    Parfrey PS, Foley RN, Wittreich BH, Sullivan DJ, Zagari MJ, Frei D (2005) Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. J Am Soc Nephrol 16:2180–2189CrossRefPubMedGoogle Scholar
  13. 13.
    Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, Lewis EF, McGill JB, McMurray JJ, Parfrey P, Parving HH, Remuzzi G, Singh AK, Solomon SD, Toto R (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361:2019–2032CrossRefPubMedGoogle Scholar
  14. 14.
    Abbott EM, Nandyala SV, Schwend RM (2014) Does a kaolin-impregnated hemostatic dressing reduce intraoperative blood loss and blood transfusions in pediatric spinal deformity surgery? Spine 39:E1174–E1180CrossRefPubMedGoogle Scholar
  15. 15.
    Fearon JA (2004) Reducing allogenic blood transfusions during pediatric cranial vault surgical procedures: a prospective analysis of blood recycling. Plast Reconstr Surg 113:1126–1130CrossRefPubMedGoogle Scholar
  16. 16.
    Fearon JA, Weinthal J (2002) The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg 109:2190–2196CrossRefPubMedGoogle Scholar
  17. 17.
    Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843CrossRefPubMedGoogle Scholar
  18. 18.
    Cameron BM, Kennedy SE, Rawlinson WD, Mackie FE (2017) The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein-Barr virus after kidney transplant in children. Pediatr Transplant 21(1)Google Scholar
  19. 19.
    (2016) Patient blood management guidelines: Module 6 – Neonatal and Paediatrics. In: Authority NB (ed). National Blood Authority, Australia, Canberra, AustraliaGoogle Scholar
  20. 20.
    Scornik JC, Schold JD, Bucci M, Meier-Kriesche H-U (2009) Effects of blood transfusions given after renal transplantation. Transplantation 87:1381–1386Google Scholar
  21. 21.
    Hoad VC, Gibbs T, Ravikumara M, Nash M, Levy A, Tracy SL, Mews C, Perkowska-Guse Z, Faddy HM, Bowden S (2017) First confirmed case of transfusion-transmitted hepatitis E in Australia. Med J Aust 206:289–290CrossRefPubMedGoogle Scholar
  22. 22.
    Rheault MN, Molony JT, Nevins T, Herzog CA, Chavers BM (2017) Hemoglobin of 12 g/dl and above is not associated with increased cardiovascular morbidity in children on hemodialysis. Kidney Int 91:177–182CrossRefPubMedGoogle Scholar
  23. 23.
    Krischock LA, van Stralen KJ, Verrina E, Tizard EJ, Bonthuis M, Reusz G, Hussain FK, Jankauskiene A, Novljan G, Spasojevic-Dimitrijeva B, Podracka L, Zaller V, Jager KJ, Schaefer F, Registry EE-E (2016) Anemia in children following renal transplantation-results from the ESPN/ERA-EDTA registry. Pediatr Nephrol 31:325–333CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  1. 1.School of Women’s & Children’s Health, UNSW MedicineUniversity of New South WalesSydneyAustralia
  2. 2.Nephrology, Sydney Children’s HospitalRandwickAustralia

Personalised recommendations