Transfusion, erythropoiesis-stimulating agent therapy, and kidney transplant wait time

Abstract

Aim: Anemia is highly prevalent among patients wait-listed for renal transplant, and management with blood transfusion or erythropoietin stimulating agents may impact transplant wait time. The purpose of this study was to examine the impact of blood transfusion and erythropoiesis stimulating agent therapy on renal transplant wait time. Methods: We retrospectively analyzed all adult patients listed for first deceased donor kidney transplantation at two transplant centers in Central Pennsylvania between 2004 and 2008. The exposures of interest were blood transfusion and erythropoietin stimulating agent therapy. Cox proportional hazards were used to model time to deceased donor kidney transplant. Results: Among 407 patients listed for transplant, 84 received a deceased donor kidney during a median follow-up of 26.3 months. In an adjusted Cox proportional hazards model, with erythropoiesis stimulating agent and transfusion both treated as time-dependent exposures, UNOS inactive status at listing date (hazard ratio [HR] 0.81; 95% CI 0.73 - 0.89; P < 0.001) and transfusion during the wait list period (HR 0.27; 95% CI 0.11 - 0.69; P = 0.01) independently predicted longer transplant wait time. Erythropoiesis stimulating agent use prior to or after transplant wait listing date did not independently predict wait time. Conclusion: Blood transfusion while waitlisted for kidney transplant is strongly associated with prolonged wait time.

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Perkins, R. , Kirchner, H. and Govindasamy, R. (2012) Transfusion, erythropoiesis-stimulating agent therapy, and kidney transplant wait time. Open Journal of Internal Medicine, 2, 1-6. doi: 10.4236/ojim.2012.21001.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Port, F.K., Wolfe, R.A., Mauger, E.A., Berling, D.P. and Jiang, K. (1993) Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. Journal of the American Medical Association, 270, 1339-1343. doi:10.1001/jama.270.11.1339
[2] Laupacis, A., Keown, P., Pus, N., Krueger, H., Ferguson, B., Wong, C. and Muirhead, N. (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney International, 50, 235-242. doi:10.1038/ki.1996.307
[3] Danovitch, G.M., Cohen, D.J., Weir, M.R., Stock, P.G., Bennet, W.M., Christensen, L.L. and Sung, R.S. (2005) Current status of kidney and pancreas transplantation in the United States, 1994-2003. American Journal of Transplantation, 5, 904-915. doi:10.1111/j.1600-6135.2005.00835.x
[4] Meier-Kriesche, H.U. and Kaplan, B. (2002) Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis. Transplantation, 74, 1377-1381. doi:10.1097/00007890-200211270-00005
[5] Mange, K.C., Joffe, M.M. and Feldman, H.I. (2001) Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. The New England Journal of Medicine, 344, 726-731. doi:10.1056/NEJM200103083441004
[6] Sanfilippo, F.P., Vaughn, W.K., Peters, T.G., Shield, C.F. 3rd, Adams, P.L., Lorber, M.I. and Williams, G.M. (1992) Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States. Journal of the American Medical Association, 267, 247-252. doi:10.1001/jama.1992.03480020057031
[7] Wolfe, R.A., Ashby, V.B., Milford, E.L., Bloembergen, W.E., Agodoa, L.Y.C., Held, P.J. and Port, F.K. (2000) Differences in access to cadaveric renal transplantation in the United States. American Journal of Kidney Diseases, 36, 1025-1033. doi:10.1053/ajkd.2000.19106
[8] Vella, J.P., O’Neill, D., Atkins, N., Donohoe, J.F. and Walshe, J.J. (1998) Sensitization to human leukocyte antigen before and after the introduction of erythropoietin. Nephrology Dialysis Transplantation, 13, 2027-2032. doi:10.1093/ndt/13.8.2027
[9] Ibrahim, H.N., Ishani, A., Foley, R.N., Guo, H., Liu, J. and Collins, A.J. (2008) Temporal trends in red blood transfusion among US dialysis patients, 1992-2005. American Journal of Kidney Diseases, 52, 1115-1121. doi:10.1053/j.ajkd.2008.07.022
[10] Lawler, E.V., Bradbury, B.D., Fonda, J.R., Gaziano, J.M. and Gagnon, D.R. (2010) Transfusion burden among patients with chronic kidney disease and anemia. Clinical Journal of the American Society of Nephrology, 5, 667-672. doi:10.2215/CJN.06020809
[11] Wu, J., Roy, J. and Stewart, W.F. (2010) Prediction modeling using EHR data: Challenges, strategies, and a comparison of machine learning approaches. Medical Care, 48, 106-113. doi:10.1097/MLR.0b013e3181de9e17
[12] Charlson, M.E., Pompei, P., Ales, K.L. and MacKenzie, C.R. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373-383. doi:10.1016/0021-9681(87)90171-8
[13] Van Es, A.A. and Balner, H. (1979) Effect of pretransplant transfusions on kidney allograft survival. Transplantation Proceedings, 11, 127-137.
[14] Lundgren, G., Groth, C.G., Albrechtsen, D., Brynger, H., Flatmark, A., Fr?din, L., G?bel, H., Husberg, B., Klintmalm, G. and Maurer, W. (1986) HLA-matching and pretransplant blood transfusions in cadaveric renal transplantation—A changing picture with cyclosporin. Lancet, 2, 66-69. doi:10.1016/S0140-6736(86)91608-9
[15] Sanfilippo, F., Vaughn, W.K., Bollinger, R.R. and Spees, E.K. (1982) Comparative effects of pregnancy, transfusion, and prior graft rejection on sensitization and renal transplant results. Transplantation, 34, 360-366. doi:10.1097/00007890-198212000-00010
[16] Kristal, B., Shurtz-Swirski, R., Shasha, S.M., Manaster, J., Shapiro, G., Furmanov, M., Hassan, K., Weissman, I. and Sela, S. (1999) Interaction between erythropoietin and peripheral polymorphonuclear leukocytes in hemodialysis patients. Nephron, 81, 406-413. doi:10.1159/000045324
[17] Strunk, T., Hartel, C., Temming, P., Matzke, N., Zimmer, J. and Schultz, C. (2008) Erythropoietin inhibits cytokine production of neonatal and adult leukocytes. Acta Paediatrica, 97, 16-20. doi:10.1111/j.1651-2227.2007.00560.x
[18] Grimm, P.C., Sinai-Trieman, L., Sekiya, N.M., Robertson, L.S., Robinson, B.J., Fine, R.N. and Ettenger, R.B. (1990) Effects of recombinant human erythropoietin on HLA sensitization and cell mediated immunity. Kidney International, 38, 12-18. doi:10.1038/ki.1990.161
[19] Koskimies, S., Lautenschlager, I., Gronhagen-Riska, C. and Hayry, P. (1990) Erythropoietin therapy and the antibody levels of highly sensitized patients awaiting kidney transplantation. Transplantation, 50, 707-709. doi:10.1097/00007890-199010000-00035
[20] Grimm, P.C., Sekiya, N.M., Robertson, L.S., Robinson, B.J. and Ettenger, R.B. (1991) Recombinant human erythropoietin decreases anti-HLA sensitization and may improve renal allograft outcome: Involvement of anti-idiotypic antibody. Transplantation Proceedings, 23, 407-408.

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