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. 2021 Nov 12;16(11):e0259270.
doi: 10.1371/journal.pone.0259270. eCollection 2021.

Blood transfusion and the risk for infections in kidney transplant patients

David Massicotte-Azarniouch  1 , Manish M Sood  2 , Dean A Fergusson  3 , Michaël Chassé  4 , Alan Tinmouth  5 , Greg A Knoll  2
Affiliations

Blood transfusion and the risk for infections in kidney transplant patients

David Massicotte-Azarniouch et al. PLoS One. .

Abstract

Background: Receipt of a red blood cell transfusion (RBCT) post-kidney transplantation may alter immunity which could predispose to subsequent infection.

Methods: We carried out a single-center, retrospective cohort study of 1,258 adult kidney transplant recipients from 2002 to 2018 (mean age 52, 64% male). The receipt of RBCT post-transplant (468 participants transfused, total 2,373 RBCT) was analyzed as a time-varying, cumulative exposure. Adjusted cox proportional hazards models were used to calculate hazard ratios (HR) for outcomes of bacterial or viral (BK or CMV) infection.

Results: Over a median follow-up of 3.8 years, bacterial infection occurred in 34% of participants at a median of 409 days post-transplant and viral infection occurred in 25% at a median of 154 days post-transplant. Transfusion was associated with a step-wise higher risk of bacterial infection (HR 1.35, 95%CI 0.95-1.91; HR 1.29, 95%CI 0.92-1.82; HR 2.63, 95%CI 1.94-3.56; HR 3.38, 95%CI 2.30-4.95, for 1, 2, 3-5 and >5 RBCT respectively), but not viral infection. These findings were consistent in multiple additional analyses, including accounting for reverse causality.

Conclusion: Blood transfusion after kidney transplant is associated with a higher risk for bacterial infection, emphasizing the need to use transfusions judiciously in this population already at risk for infections.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. One-year incidence rates (per 100 person-years) of RBCT by year of transplant.
For example, individuals receiving their kidney transplant in 2012 had a one-year incidence of blood transfusion of approximately 50 transfusions per 100 person-years of follow-up. Figure represents the same transfusion data as in a prior study reported by our group [20].
Fig 2
Fig 2. Kaplan-meier crude cumulative incidence curves for outcomes by transfusion status.
A) Bacterial infections. B) Viral infections. Shown are the total number of infections, the 1, 5 and 10-year cumulative incidences as well as the crude Kaplan-meier cumulative incidence curves by transfusion status.
See this image and copyright information in PMC

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