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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.
Background:
Recent surgical literature suggests that a relative decrease in hemoglobin (ΔHb) is predictive of adverse outcomes regardless of the absolute level. We aimed to examine the association between perioperative ΔHb and kidney transplantation (KT) outcomes.
Methods:
This was a retrospective cohort study of transplant recipients, where ΔHb = [Hb0- Hb1Hb0]x 100 (Hb0 = hemoglobin pre-KT and Hb1 = lowest hemoglobin 24-h post-KT). The main outcome of interest was immediate graft function (IGF).
Results:
Of the 899 eligible patients, 38% experienced IGF, and ΔHb was associated with 36% lower odds of IGF. Also, ΔHb was associated with higher all-cause graft failure and longer length of stay but not death-censored graft failure or mortality. ΔHb ≥30% was the threshold beyond which the odds of IGF were significantly lower even if Hb1 was ≥7 g/dL.
Conclusion:
ΔHb is associated with inferior outcomes independent of Hb1; whether it can be used to guide transfusion practices should be explored.
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