• J Salvador de la Cruz, Mitchell B Sally, John R Zatarain, Megan Crutchfield, Katrina Ramsey, Jamison Nielsen, Madhukar Patel, Jodi Lapidus, Susan Orloff, and Darren J Malinoski.
• From the Surgical Critical Care Section (J.S.D.L.C., M.B.S., M.C., J.N., S.O., D.J.M.), Portland Veterans Affairs Medical Center; and Department of Surgery (J.S.D.L.C., M.B.S., K.R., J.N., S.O., D.J.M.), Oregon Health & Science University, Portland, Oregon; Department of Surgery (J.R.Z.), University of Texas Medical Branch, Galveston, Texas; Department of Surgery (M.P.), Massachusetts General Hospital, Boston, Massachusetts.
• J Trauma Acute Care Surg. 2015 Oct 1; 79 (4 Suppl 2): S164-70.

BackgroundHistorically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).MethodsDonor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.ResultsData were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p < 0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.ConclusionAny BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.Level Of EvidenceTherapeutic study, level III; epidemiologic/prognostic study, level II.

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