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. 2021 Oct;222(4):825-831.
doi: 10.1016/j.amjsurg.2021.03.002. Epub 2021 Mar 5.

Relative decrease in hemoglobin and outcomes in patients undergoing kidney transplantation surgery: A retrospective cohort study

Sarah MacIsaac  1 , Agnihotram V Ramanakumar  2 , Chee Saw  3 , Veronique Naessens  4 , Nasim Saberi  5 , Marcelo Cantarovich  6 , Dana Baran  7 , Steven Paraskevas  8 , Jean Tchervenkov  9 , Prosanto Chaudhury  10 , Shaifali Sandal  11
Affiliations

Relative decrease in hemoglobin and outcomes in patients undergoing kidney transplantation surgery: A retrospective cohort study

Sarah MacIsaac et al. Am J Surg. 2021 Oct.

Abstract

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.

Keywords: Anemia; Blood transfusion; Hemoglobin; Kidney transplantation; Transplant outcomes.

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Conflict of interest statement

Declaration of competing interest Dr. Sandal has received an education grant from Amgen to increase living donor kidney transplantation. In the past five years, Dr Chaudhury discloses Ad board and honoraria from Ipsen and Novartis Oncology. Dr. Tchervenkov discloses that he has received a PI initiated Astellas/Canadian Society of Transplantation Research Support that ended in 2018. The other authors have no relevant disclosures.

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