Extended RBC Storage Linked to Reduced Risk of Transplant Failure in Kidney Transplant Recipients

By Cailin Conner - Last Updated: September 25, 2023

According to a recent study in JAMA Network Open, extended storage of red blood cells (RBCs) correlated with increased transplant longevity in patients who underwent early post-transplant transfusions following kidney transplant.

“Red blood cell transfusion (RBCT) is frequently required in the early post-kidney transplant period, but long-term outcomes associated with RBCT [are] controversial,” the authors of the study wrote. “Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes.”

This comprehensive study, which encompassed 12,559 patients who received their first kidney transplant between January 2002 and December 2008, utilized data from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. Patients were followed up from the time of transplant until graft loss, death with a functional graft, or data retrieval in June 2016. The study’s primary objective was to analyze the impact of RBC storage duration on transplant outcomes.

A total of 3483 patients received an RBCT within the first 14 days post-transplant. The median patient age was 53.0 years, and 55.4% were male. The median follow-up duration was 7.8 years. The study revealed a significant association between the storage duration of transfused RBCs and the risk of transplant failure.

Following multivariable analysis, researchers noted that longer storage duration of RBCs was linked to a decrease in the risk of transplant failure. Specifically, for each additional storage day of RBCs, there was a statistically significant decrease in the hazard ratio, indicating a lower risk of graft loss or death with a functional graft. Although the association was not highly significant (P=.06), the trend was evident.

Moreover, patients who received at least 1 RBC unit stored for more than 20 days experienced a substantial benefit in transplant outcomes. They exhibited a 5% absolute decrease in transplant failure at 3 years and a 7% decrease at 5 years compared with those who received RBCs stored for less than 20 days.

“Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion,” the investigators concluded.

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