Blood transfusion in deceased donor kidney transplantation

Given the unpredictable timing of deceased donor organs and the need for blood transfusion, this study was carried out to determine the rate and risk factors for transfusion in order to identifying a low-risk cohort in the face of a critical blood shortage.

This retrospective chart review examined 306 consecutive deceased solitary kidney transplant recipients from January 2006 to August 2012.

Records show that 80 (26.1%) patients were transfused with a total of 300 units (0.98 units/transplant) during their first hospital stay. Transfusions were higher in patients on warfarin (8/14, 57%, 5.1 units/transplant) and antiplatelet agents (46/136, 33.8%, 1.1 unit/transplant) compared to no anticoagulants (74/156, 16.7%, 0.47 units/transplant). In a multivariable logistic regression analysis warfarin (odd ratio (OR) 8.2, 95% confidence interval (CI) 2.5-27, P=0.001), antiplatelet agents (OR 2.9, 95% CI 1.6-5.3, P=0.001), recipient age ≥55 years (OR 2.2, 95% CI 1.2-3.9, P=0.008), recipient male (OR 0.36, 95% CI 0.2-0.64, P=0.001) and preop hemoglobin ≥115 g/L (OR 0.32, 95% CI 0.18-0.57, P<0.001) were independent predictors of blood transfusion. Lower bleeding cohorts with transfusion rates <5% could not be identified.

The need for blood is significantly higher in subjects on either warfarin or antiplatelet agents. These patients might be avoided if kidney transplantation is to occur during a critical blood shortage. Unfortunately even patients not on anticoagulation are at some risk.