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. 2023 Sep 5;6(9):e2332821.
doi: 10.1001/jamanetworkopen.2023.32821.

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Emilie Gaiffe  1 , Dewi Vernerey  1   2 , Laurent Bardiaux  3 , Franck Leroux  4 , Aurelia Meurisse  1   2 , Jamal Bamoulid  1   5 , Cecile Courivaud  1   5 , Philippe Saas  1   4 , Marc Hazzan  6 , Pierre Tiberghien  1   7 , Didier Ducloux  1   5
Affiliations

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Emilie Gaiffe et al. JAMA Netw Open. .

Erratum in

  • Error in Results.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Oct 2;6(10):e2341773. doi: 10.1001/jamanetworkopen.2023.41773. JAMA Netw Open. 2023. PMID: 37862020 Free PMC article. No abstract available.

Abstract

Importance: Red blood cell transfusion (RBCT) is frequently required in the early post-kidney transplant period, but long-term outcomes associated with RBCT is controversial. Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes.

Objective: To study the association between RBC storage duration and transplant outcomes.

Design, setting, and participants: This was a nationwide retrospective cohort study based on data linking between 2 prospective French nationwide registries. Clinical transplant parameters, outcomes, and RBCT characteristics were extracted from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. All 12 559 patients having received a first kidney transplant in France between January 1, 2002, and December 31, 2008, were included. Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022.

Exposures: Clinical outcomes of transplant recipients who underwent early RBCT were analyzed considering transfusion characteristics.

Main outcomes and measures: Cox proportional hazards regression models were fitted to evaluate transplant failure defined as graft loss or death with a functional graft.

Results: Among 12 559 patients who underwent kidney transplant, 3483 received an RBCT during the first 14 days posttransplant. The median (IQR) age of patients was 53.0 (41.5-61.2) years, and 1929 patients (55.4%) were male. Median (IQR) follow-up was 7.8 (7.6-8.0) years. In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in risk of transplant failure (hazard ratio, 0.99; 95% CI, 0.98-1.00 for each additional storage day; P = .06). Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days.

Conclusions and relevance: In this study, longer RBC storage duration was associated with a decreased risk of transplant failure among patients who received kidney transplants and RBC transfusions. Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Bardiaux, Saas, and Tiberghien are employed by the French transfusion public service (EFS) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Transplant Failure–Free Survival Curves for Patients According Transfusion Characteristics
RBC indicates red blood cell.
Figure 2.
Figure 2.. Kaplan-Meier Transplant Survival Curve for Patients According to Red Blood Cell (RBC) Storage Duration
Patients who received transfusions with RBC stored for more than 20 days or for 20 days or less were followed up for 10 years.
Figure 3.
Figure 3.. Cumulative Incidence Function Estimate With Fine and Gray Model for Competitive Risk Analysis
Model includes 3483 patients, 670 graft loss events, and 548 deaths during transplant. RBC indicates red blood cell; RBCT, red blood cell transfusion.
See this image and copyright information in PMC

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