THE TIMING OF PRETRANSPLANT TRANSFUSIONS AND RENAL ALLOGRAFT SURVIVAL

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Abstract
Analysis of over 3000 cadaveric renal allograft recipients transplanted between June 1977-June 1982 as part of the South-Eastern Organ Procurement Foundation Prospective Study was performed to determine the influence of timing of blood transfusions (BT) on patient and graft survival. Four mutually exclusive BT groups were identified for 2480 1st-transplant and 655 regrafted patients studied: group 1 (n = 348, 29, respectively), received no BT; group 2 (n = 256, 29, respectively), received perioperative BT only (i.e., at the time of, or within 10 days of transplant); group 3 (n = 972, 287, respectively), received preoperative BT only (i.e., 10 or more days pretransplant); group 4 (n = 904, 310, respectively), received both preoperative and perioperative BT. For 1st graft recipients, actuarial graft survival for group 2 was significantly greater (P < 0.035) than group 1 (49% vs. 41% at 1 yr; 35% vs. 25% at 4 yr), but to a lesser degree than groups 3 or 4, which were equivalent (58% at 1 yr and 38% at 4 yr). For regrafted patients, actuarial graft survival was again significantly greater (P < 0.03) for group 2 patients, compared with group 1 (59% vs. 29% at one year), and group 3 and 4 patients were not significantly different from each other (45% and 48% at 1 yr, respectively) or from group 2. For regrafted patients who were presensitized at the time of transplant, those in group 4 (n = 94) had significantly better graft survival than group 3 (n = 111) at all time points examined (54% vs. 47% at 1 yr, 46% vs. 22% at 3 yr). In all comparisons, increases in graft survival were associated with decreased graft loss resulting from rejection, and no significant differences in patient survival were seen between any of these groups. These findings indicate that: perioperative transfusions alone may have benefit in decreasing allograft rejection; perioperative transfusions provide no apparent risk for patients who have already received pretransplant transfusions; and, sensitized regrafted patients who receive pretransplant transfusions may gain an additional benefit from perioperative transfusions.