Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil.
Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil.
Transpl Immunol. 2023 Apr;77:101807. doi: 10.1016/j.trim.2023.101807. Epub 2023 Feb 24.
Anemia in chronic kidney disease is of great concern regarding blood transfusions and the possibility of allosensitization for future kidney transplants and the occurrence of rejection and allograft loss in the post-transplant period. The aim of this study was to evaluate the effect of early blood transfusion on the occurrence of rejections, allograft function and survival in the first year after transplantation.
This retrospective study was carried out with 445 patients submitted to kidney transplant allocated to two groups. The first group received early blood transfusions after transplant (n = 125, 28.09%), and the second group did not receive blood transfusions (n = 320, 71.91%). The patient outcomes were evaluated during a 1-year follow-up.
14 patients given blood transfusion (11.2%) lost their allograft in the first year in comparison with 8 (2.5%) without transfusion (p < 0.001). There were 9 deaths in each group, which corresponded to 7.2% of the patients who received blood transfusions and 2.81% of those who did not (p < 0.035). Patient hospitalization lasted 15 days in transfusion group and 8.5 days in non-transfusion group (p < 0.001). Creatinine levels were higher in the patients who received blood transfusion than in those without transfusion in the first and third months after transplantation (p = 0.012 and 0.038, respectively). During the first year, the patients who received blood products experienced more antibody-mediated rejection (ABMR) (13.60%) than patients who did not (4.38%) (p < 0.001). Those who received blood transfusions also developed de novo DSA in higher proportion than those without transfusion against both class I and class II HLA (p < 0.001).
This study showed that blood transfusions in the first month after transplantation had a negative impact on kidney function, graft survival, and contributed to the development of de novo DSA, an increased risk of ABMR and infections.
慢性肾脏病患者的贫血问题令人关注，因为这可能需要输血，而且可能导致对未来肾移植的同种异体致敏，以及在移植后排斥反应和移植物丢失。本研究旨在评估早期输血对移植后 1 年内排斥反应、移植物功能和存活率的影响。
本回顾性研究纳入 445 例接受肾移植的患者，将其分为两组。第一组在移植后接受早期输血（n=125，28.09%），第二组未接受输血（n=320，71.91%）。在 1 年的随访期间评估患者结局。
在接受输血的 14 例患者（11.2%）中，有 14 例在第 1 年内失去了移植物，而未输血的 8 例患者（2.5%）则未发生这种情况（p<0.001）。两组各有 9 例死亡，分别占接受输血患者的 7.2%和未输血患者的 2.81%（p<0.035）。输血组患者的住院时间为 15 天，未输血组为 8.5 天（p<0.001）。移植后第 1 个月和第 3 个月，接受输血的患者的肌酐水平高于未输血的患者（p=0.012 和 0.038）。在第 1 年内，接受血液制品的患者发生抗体介导的排斥反应（ABMR）的比例（13.60%）高于未接受血液制品的患者（4.38%）（p<0.001）。与未输血的患者相比，接受输血的患者也更易产生针对 HLA Ⅰ类和Ⅱ类的新发性 dsDNA（p<0.001）。
本研究表明，移植后 1 个月内输血对肾功能、移植物存活率有负面影响，并导致新发性 dsDNA 的产生、ABMR 风险增加和感染。
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