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Relative decrease in hemoglobin and outcomes in patients undergoing kidney transplantation surgery: A retrospective
Sarah MacIsaac1, Agnihotram V Ramanakumar2, Chee Saw3
1Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
American Journal of Surgery
|March 12, 2021
Summary
A significant drop in hemoglobin after kidney transplant (KT) predicts worse outcomes, including lower immediate graft function (IGF) and increased graft failure, regardless of the final hemoglobin level. This highlights the importance of monitoring relative hemoglobin changes.
Area of Science:
- Nephrology
- Transplantation Surgery
- Anesthesiology
Background:
- Recent surgical literature indicates relative hemoglobin decrease (ΔHb) predicts adverse outcomes.
- The association between perioperative ΔHb and kidney transplantation (KT) outcomes requires examination.
Purpose of the Study:
- To investigate the relationship between perioperative ΔHb and kidney transplantation outcomes.
- To determine if ΔHb is an independent predictor of graft function and survival.
Main Methods:
- Retrospective cohort study of 899 kidney transplant recipients.
- ΔHb calculated as ([pre-KT Hb] - [lowest post-KT Hb]) / [pre-KT Hb] x 100.
- Primary outcome: immediate graft function (IGF); secondary outcomes: graft failure, mortality, length of stay.
Main Results:
- 38% of patients experienced IGF.
- ΔHb was associated with 36% lower odds of IGF.
- Higher ΔHb correlated with increased all-cause graft failure and longer hospital stay, but not death-censored graft failure or mortality.
- A ΔHb threshold of ≥30% significantly reduced IGF odds, even with post-KT Hb ≥7 g/dL.
Conclusions:
- Perioperative ΔHb is linked to poorer kidney transplant outcomes, independent of absolute post-transplant hemoglobin levels.
- Further research is needed to explore the utility of ΔHb in guiding transfusion strategies post-KT.
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