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Updated: May 22, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
The Association Between Platelet Transfusion and Acute Kidney Injury Following Fontan Surgery
Marianne E Nellis1, Asaf Mandel2,3, Yshia Langer2,3
1Division of Pediatric Critical Care, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
Insights
Platelet transfusions in children undergoing the Fontan procedure are linked to a higher risk of severe acute kidney injury (AKI). Careful consideration of transfusion risks versus benefits is crucial for these young patients.
Area of Science:
- Pediatric Cardiology
- Transfusion Medicine
- Nephrology
Background:
- The Fontan procedure is a complex surgery for single-ventricle congenital heart defects.
- Organ dysfunction, including acute kidney injury (AKI), is a known complication post-Fontan.
- The role of blood component transfusions in AKI development after Fontan is not fully elucidated.
Purpose of the Study:
- To investigate the association between blood component transfusions (red blood cells, plasma, platelets, cryoprecipitate) and the incidence of AKI in children after the Fontan procedure.
- To identify specific blood products that may contribute to AKI development.
Main Methods:
- Retrospective cohort study of 88 children undergoing the Fontan procedure between 2009 and 2016.
- Data collected included transfusion records and laboratory values to assess AKI using Kidney Disease Improving Global Outcomes criteria.
- Multivariable regression analysis was used to adjust for potential confounders.
Main Results:
- 41% of children developed stage 1 AKI, 23% stage 2 AKI, and 15% stage 3 AKI post-surgery.
- A significant proportion of children received red blood cell (58%), plasma (73%), and platelet (47%) transfusions.
- Each 1 mL/kg increase in platelet transfusion was independently associated with an increased risk of severe AKI (OR: 1.160, P=.041).
Conclusions:
- Platelet transfusion is an independent risk factor for severe postoperative AKI in children following the Fontan procedure.
- This finding highlights the need for careful risk-benefit assessment of platelet transfusions in this vulnerable population.
- Further research into transfusion strategies and alternatives may be warranted to mitigate AKI risk.
Abstract:
Objectives: Previous studies have demonstrated an association between transfusion and increased organ dysfunction. We sought to determine the association between transfusion of blood components (red blood cell [RBC], plasma, platelet, and cryoprecipitate transfusions) with development of acute kidney injury (AKI) in children following the Fontan procedure. Methods: This is a single center, retrospective cohort study from 2009 to 2016. All children who underwent the Fontan procedure during the prescribed period who had transfusion and laboratory data available were included. Results: Eighty-eight children were enrolled. The median (interquartile range [IQR]) age was 4.5 (3.3-6.0) years, and median (IQR) weight was 14.8 (13.0-18.8) kg. The median (IQR) cardiopulmonary bypass (CPB) time was 62 (47-89) minutes. Following surgery, according to Kidney Disease Improving Global Outcomes criteria, 41% (36/88) had stage 1 AKI, 23% (20/88) stage 2 AKI, and 15% (13/88) stage 3 AKI. Fifty-eight percent (51/88) of children received at least one RBC transfusion, 73% (64/88) received at least one plasma transfusion, 47% (41/88) received at least one platelet transfusion, and 28% (25/88) received at least one cryoprecipitate transfusion. Children with severe AKI received more of each blood component. After adjusting for age, weight, pre-Fontan pulmonary vascular resistance, pre-Fontan dominant ventricular end-diastolic pressure, CPB time, RBC dose, plasma dose, and cryoprecipitate dose, each 1 mL/kg of platelet transfusion was associated with an increased risk in development of severe AKI (odds ratio: 1.160, 95%CI 1.006-1.339, P = .041). Conclusions: In our cohort of children undergoing the Fontan procedure, platelet transfusion was independently associated with an increased risk of severe AKI postoperatively. The risks, benefits, and alternatives to transfusion should be carefully weighed in this patient population.
