Mazzeffi Michael, Jonna Srikar, Blanco Natalia, Mavrothalassitis Orestes, Odekwu Obi, Fontaine Magali, Rock Peter, Tanaka Kenichi, Thom Kerri
University of Maryland School of Medicine, 22 South Greene Street S11C00, Baltimore, MD, 21201, USA.
J Anesth. 2018 Jun;32(3):368-374. doi: 10.1007/s00540-018-2484-x. Epub 2018 Mar 20.
Kidney transplant patients are frequently anemic and at risk for red blood cell (RBC) transfusion. Previous studies suggest that pre-transplant RBC transfusion may improve kidney transplant outcomes; however, RBC transfusion is also associated with infection. The purpose of our study was to characterize the relationships between intraoperative RBC transfusion, delayed graft function (DGF), postoperative surgical site infection (SSI), and sepsis.
Analysis was performed on a historical cohort of adult kidney transplant patients from a single medical center during a two-year period. Crude odds ratios for DGF, superficial and deep SSI, and sepsis were calculated for transfused patients and multivariate regression was used to control for potential confounders when significant relationships were identified.
Four hundred forty-one patients had kidney transplant during the study period; 27.0% had RBC transfusion, 38.8% had DGF, 7.0% had superficial SSI, 7.9% had deep SSI, and 1.8% had sepsis. High dose RBC transfusion was associated with improved graft function, but this was negated after adjusting for confounders (OR = 0.86, 95% CI 0.26 to 2.88). There was no association between RBC transfusion and SSI. RBC transfusion was independently associated with sepsis (OR = 8.98, 95% CI 1.52 to 53.22), but the confidence interval was wide.
Intraoperative RBC transfusion during kidney transplant is not associated with improved allograft function or incisional SSI, but is associated with postoperative sepsis. RBCs should not be liberally transfused during kidney transplant surgery to improve graft outcomes.
肾移植患者常伴有贫血且有红细胞（RBC）输血风险。既往研究表明，移植前红细胞输血可能改善肾移植结局；然而，红细胞输血也与感染相关。我们研究的目的是描述术中红细胞输血、移植肾功能延迟恢复（DGF）、术后手术部位感染（SSI）和脓毒症之间的关系。
对某单一医疗中心两年期间成年肾移植患者的历史队列进行分析。计算输血患者发生DGF、浅表和深部SSI以及脓毒症的粗比值比，当发现显著关系时，采用多因素回归控制潜在混杂因素。
在研究期间，441例患者接受了肾移植；27.0%的患者接受了红细胞输血，38.8%的患者发生DGF，7.0%的患者发生浅表SSI，7.9%的患者发生深部SSI，1.8%的患者发生脓毒症。高剂量红细胞输血与移植肾功能改善相关，但在调整混杂因素后这种相关性消失（OR = 0.86，95%CI 0.26至2.88）。红细胞输血与SSI之间无关联。红细胞输血与脓毒症独立相关（OR = 8.98，95%CI 1.52至53.22），但置信区间较宽。
肾移植术中红细胞输血与同种异体移植肾功能改善或切口SSI无关，但与术后脓毒症相关。肾移植手术期间不应随意输注红细胞以改善移植结局。
