An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival

Juan C. Scornik, Jonathan S. Bromberg, Douglas Norman, Mayank Bhanderi, Matthew Gitlin, Jeffrey Petersen

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Blood transfusions have the potential to improve graft survival, induce sensitization, and transmit infections. Current clinical practice is to minimize transfusions in renal transplantation candidates, but it is unclear if the evidence continues to support pre-transplant transfusion avoidance. Changes in the Medicare prospective payment system may increase transfusion rates. Thus there is a need to re-evaluate the literature to improve the management options for renal transplant candidates. Methods. A review applying a systematic approach and conducted using MEDLINE®, Embase®, and the Cochrane Library for English-language publications (timeframe: 01/1984-03/2011) captured 180 studies and data from publically available registries and assessed the impact of transfusions on allosensitization and graft survival, and the impact of allosensitization on graft survival and wait time. Results: Blood transfusions continued to be a major cause of allosensitization, with allosensitization associated with increased rejection and graft loss, and longer wait times to transplantation. Although older studies showed a beneficial effect of transfusion on graft survival, this benefit has largely disappeared in the post-cyclosporine era due to improved graft outcomes with current practice. Recent data suggested that it may be the donor-specific antibody component of allosensitization that carried the risk to graft outcomes. Conclusions: Results of this review indicated that avoiding transfusions whenever possible is a sound management option that could prevent detrimental effects in patients awaiting kidney transplantation.

Original languageEnglish (US)
Article number217
JournalBMC Nephrology
Volume14
Issue number1
DOIs
StatePublished - 2013

Fingerprint

Graft Survival
Allografts
Transplants
Kidney
Blood Transfusion
Kidney Transplantation
Prospective Payment System
Graft Rejection
Medicare
MEDLINE
Cyclosporine
Libraries
Registries
Publications
Language
Transplantation
Tissue Donors
Antibodies
Infection

Keywords

  • Allosensitization
  • Graft survival
  • Renal transplant
  • Transfusion

ASJC Scopus subject areas

  • Nephrology

Cite this

An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival. / Scornik, Juan C.; Bromberg, Jonathan S.; Norman, Douglas; Bhanderi, Mayank; Gitlin, Matthew; Petersen, Jeffrey.

In: BMC Nephrology, Vol. 14, No. 1, 217, 2013.

Research output: Contribution to journalArticle

Scornik, Juan C. ; Bromberg, Jonathan S. ; Norman, Douglas ; Bhanderi, Mayank ; Gitlin, Matthew ; Petersen, Jeffrey. / An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival. In: BMC Nephrology. 2013 ; Vol. 14, No. 1.
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