The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5

J. Salvador de la Cruz, Mitchell B. Sally, John R. Zatarain, Megan Crutchfield, Katrina Ramsey, Jamison Nielsen, Madhukar Patel, Jodi Lapidus, Susan Orloff, Darren J. Malinoski

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).

METHODS: Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.

RESULTS: Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p <0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.

CONCLUSION: Any BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.

LEVEL OF EVIDENCE: Therapeutic study, level III; epidemiologic/prognostic study, level II.

Original languageEnglish (US)
Pages (from-to)S164-S170
JournalThe journal of trauma and acute care surgery
Volume79
Issue number4
DOIs
StatePublished - Oct 1 2015

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Blood Transfusion
Delayed Graft Function
Tissue Donors
Transplants
Kidney
Nervous System
Critical Care
Transplantation
Erythrocytes
Demography
Graft Survival
Blood Group Antigens
Immunosuppression
Epidemiologic Studies
Dialysis
Odds Ratio
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Medicine(all)

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The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5. / de la Cruz, J. Salvador; Sally, Mitchell B.; Zatarain, John R.; Crutchfield, Megan; Ramsey, Katrina; Nielsen, Jamison; Patel, Madhukar; Lapidus, Jodi; Orloff, Susan; Malinoski, Darren J.

In: The journal of trauma and acute care surgery, Vol. 79, No. 4, 01.10.2015, p. S164-S170.

Research output: Contribution to journalArticle

de la Cruz, JS, Sally, MB, Zatarain, JR, Crutchfield, M, Ramsey, K, Nielsen, J, Patel, M, Lapidus, J, Orloff, S & Malinoski, DJ 2015, 'The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5', The journal of trauma and acute care surgery, vol. 79, no. 4, pp. S164-S170. https://doi.org/10.1097/TA.0000000000000670
de la Cruz, J. Salvador ; Sally, Mitchell B. ; Zatarain, John R. ; Crutchfield, Megan ; Ramsey, Katrina ; Nielsen, Jamison ; Patel, Madhukar ; Lapidus, Jodi ; Orloff, Susan ; Malinoski, Darren J. / The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5. In: The journal of trauma and acute care surgery. 2015 ; Vol. 79, No. 4. pp. S164-S170.
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abstract = "BACKGROUND: Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).METHODS: Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.RESULTS: Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52{\%} received any BT, 32{\%} received 1 to 5 U, 11{\%} received 6 to 10, and 9{\%} received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26{\%} vs. 34{\%}, p <0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.CONCLUSION: Any BT in a DNDD was associated with a 23{\%} decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.LEVEL OF EVIDENCE: Therapeutic study, level III; epidemiologic/prognostic study, level II.",
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T1 - The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5

AU - de la Cruz, J. Salvador

AU - Sally, Mitchell B.

AU - Zatarain, John R.

AU - Crutchfield, Megan

AU - Ramsey, Katrina

AU - Nielsen, Jamison

AU - Patel, Madhukar

AU - Lapidus, Jodi

AU - Orloff, Susan

AU - Malinoski, Darren J.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - BACKGROUND: Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).METHODS: Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.RESULTS: Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p <0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.CONCLUSION: Any BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.LEVEL OF EVIDENCE: Therapeutic study, level III; epidemiologic/prognostic study, level II.

AB - BACKGROUND: Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).METHODS: Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.RESULTS: Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p <0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.CONCLUSION: Any BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.LEVEL OF EVIDENCE: Therapeutic study, level III; epidemiologic/prognostic study, level II.

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