Massicotte-Azarniouch David, Sood Manish M, Fergusson Dean A, Chassé Michaël, Tinmouth Alan, Knoll Greg A
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Transfusion. 2022 Dec;62(12):2480-2489. doi: 10.1111/trf.17154. Epub 2022 Nov 3.
Red blood cell transfusion (RBCT) is common after kidney transplantation and could have pro-thrombotic effects predisposing to venous thromboembolism (VTE). The risks for developing of VTE after RBCT in kidney transplant patients are unknown.
This was a retrospective cohort study of adult kidney transplant recipients from 2002 to 2018. The exposure of interest was receipt of RBCT after transplant. Cox proportional hazards models were used to calculate hazard ratios (HR) for the outcomes of venous thromboembolism [VTE] (deep venous thrombosis [DVT] or pulmonary embolism [PE]) using RBCT as a time-varying, cumulative exposure.
Out of 1258 kidney transplants recipients, 468 (37%) were transfused during the study period. Seventy-nine study participants (6.3%) developed VTE, 72 DVT (5.7%), and 22 PE (1.8%). For the receipt of 1, 2, 3-5, and >5 RBCT, compared to individuals never transfused, the number of events and adjusted HR (95%CI) for VTE were 6 (6.2%) HR 1.57 (0.69-3.58), 9 (7.6%) HR 2.54 (1.30-4.96), 15 (11.9%) HR 2.73 (1.38-5.41), and 23 (18.1%) HR 5.77 (2.99-11.14) respectively; for DVT, it was 6 (6.2%) HR 1.94 (0.84-4.48), 9 (7.6%) HR 2.92 (1.44-5.94), 14 (11.1%) HR 3.29 (1.63-6.65), and 21 (16.5%) HR 6.97 (3.53-13.76), respectively. For PE, among transfused individuals, there were 14 events (3.0%) and the HR was 2.40 (1.02-5.61).
The risks for developing VTE, DVT, and PE were significantly increased in kidney transplant patients receiving RBCT after transplant. Receipt of RBCT should prompt considerations for judicious monitoring and assessment for thrombosis.
肾移植后红细胞输血（RBCT）很常见，且可能具有促血栓形成作用，易引发静脉血栓栓塞（VTE）。肾移植患者RBCT后发生VTE的风险尚不清楚。
这是一项对2002年至2018年成年肾移植受者的回顾性队列研究。感兴趣的暴露因素是移植后接受RBCT。使用Cox比例风险模型，将RBCT作为随时间变化的累积暴露因素，计算静脉血栓栓塞[VTE]（深静脉血栓形成[DVT]或肺栓塞[PE]）结局的风险比（HR）。
在1258名肾移植受者中，468名（37%）在研究期间接受了输血。79名研究参与者（6.3%）发生了VTE，72例DVT（5.7%），22例PE（1.8%）。与从未输血的个体相比，接受1次、2次、3 - 5次和>5次RBCT后，VTE的事件数和调整后的HR（95%CI）分别为6例（6.2%），HR 1.57（0.69 - 3.58）；9例（7.6%），HR 2.54（1.30 - 4.96）；15例（11.9%），HR 2.73（1.38 - 5.41）；23例（18.1%），HR 5.77（2.99 - 11.14）；对于DVT，分别为6例（6.2%），HR 1.94（0.84 - 4.48）；9例（7.6%），HR 2.92（1.44 - 5.94）；14例（11.1%），HR 3.29（1.63 - 6.65）；21例（16.5%），HR 6.97（3.53 - 13.76）。对于PE，在输血个体中，有14例事件（3.0%），HR为2.40（1.02 - 5.61）。
肾移植后接受RBCT的患者发生VTE、DVT和PE的风险显著增加。接受RBCT后应考虑进行明智的血栓监测和评估。
