Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
J Korean Med Sci. 2023 Jul 17;38(28):e212. doi: 10.3346/jkms.2023.38.e212.
This study investigated the associations between transfusion of different types of red blood cell (RBC) preparations and kidney allograft outcomes after kidney transplantation (KT) over a 16-year period in Korea using a nationwide population-based cohort.
We investigated the reported use of RBCs during hospitalization for KT surgery, rejection, and graft failure status using nationwide data from the National Health Information Database (2002-2017). The associations between the type of perioperative RBC product and transplant outcomes were evaluated among four predefined groups: no RBC transfusion, filtered RBCs, washed RBCs, and packed RBCs (pRBCs).
A total of 17,754 KT patients was included, among which 8,530 (48.0%) received some type of RBC transfusion. Of the patients who received RBC transfusion, 74.9%, 19.7%, and 5.4% received filtered RBCs, pRBCs, or washed RBCs, respectively. Regardless of the type of RBC products, the proportions of acute rejection and graft failure was significantly greater in patients receiving transfusion ( < 0.001). Cox proportional hazards regression analyses showed that the filtered RBC and pRBC groups were significantly associated with both rejection and graft failure. The washed RBC group also had hazard ratios greater than 1.0 for rejection and graft failure, but the association was not significant. Rejection-free survival of the pRBC group was significantly lower than that of the other groups ( < 0.001, log-rank test), and graft survival for the no RBC transfusion group was significantly greater than in the other groups ( < 0.001, log-rank test).
Perioperative RBC transfusion was associated with poor graft outcomes. Notably, transfusion of pRBCs significantly increased transplant rejection. Therefore, careful consideration of indications for RBC transfusion and selection of the appropriate type of RBCs is necessary, especially for patients at high risk of rejection or graft failure.
本研究使用全国人群队列，在韩国 16 年间调查了不同类型的红细胞（RBC）制剂的输血与肾移植（KT）后肾移植物结局之间的关系。
我们使用国家健康信息数据库（2002-2017 年）的全国数据调查了 KT 手术住院期间报告的 RBC 使用情况、排斥反应和移植物失功情况。在四个预先设定的组中评估了围手术期 RBC 产品类型与移植结局之间的关系：无 RBC 输血、过滤 RBC、洗涤 RBC 和浓缩 RBC（pRBC）。
共纳入 17754 例 KT 患者，其中 8530 例（48.0%）接受了某种类型的 RBC 输血。在接受 RBC 输血的患者中，分别有 74.9%、19.7%和 5.4%接受了过滤 RBC、pRBC 或洗涤 RBC。无论 RBC 产品类型如何，输血患者的急性排斥反应和移植物失功比例均显著更高（<0.001）。Cox 比例风险回归分析显示，过滤 RBC 和 pRBC 组与排斥反应和移植物失功均显著相关。洗涤 RBC 组的排斥反应和移植物失功比值比也大于 1.0，但相关性无统计学意义。pRBC 组的无排斥反应生存显著低于其他组（<0.001，log-rank 检验），无 RBC 输血组的移植物生存显著大于其他组（<0.001，log-rank 检验）。
围手术期 RBC 输血与移植物不良结局相关。值得注意的是，pRBC 输血显著增加了移植排斥反应。因此，有必要仔细考虑 RBC 输血的适应证，并选择适当的 RBC 类型，尤其是对排斥反应或移植物失功风险较高的患者。
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