Assessing the Necessity of Routine Crossmatching for Blood Transfusion in Renal Transplantation

Area of Science:

• Nephrology
• Transplantation Medicine
• Hematology

Background:

• Routine preoperative crossmatching of packed red blood cells (pRBCs) is common before renal transplantation, but evidence on transfusion incidence is conflicting.
• Resource allocation in healthcare necessitates medically appropriate and judicious use of resources, including blood products.

Purpose of the Study:

• To determine the incidence, timing, and predictors of early postoperative pRBC transfusion in patients undergoing renal transplantation.

Main Methods:

• Retrospective review of 428 renal transplant recipients from January 2013 to May 2016.
• Data collected included demographic, biochemical, and clinical parameters.
• Multivariable logistic regression identified associations with early postoperative transfusion (intraoperative or within 2 days of surgery).

Main Results:

• Early postoperative transfusion was required by 9.3% of patients (40/428), with a mean of 2.8 pRBCs per transfusion.
• Only 4.7% of patients (20/428) received transfusion intraoperatively or on the day of surgery.
• Predictors of early postoperative transfusion included lower preoperative hemoglobin, female gender, and preoperative antithrombotic use.

Conclusions:

• The low incidence (<10%) of early postoperative transfusion suggests routine crossmatch may not be universally required for renal transplant patients.
• Preoperative hemoglobin levels, female gender, and antithrombotic use are associated with an increased risk of transfusion.
• These factors can help risk-stratify patients who may benefit from preoperative crossmatching.