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In-Depth Reviews
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Effect of Red Cell Transfusions on Future Kidney Transplantation

Gregorio T. Obrador and Iain C. Macdougall
CJASN May 2013, 8 (5) 852-860; DOI: https://doi.org/10.2215/CJN.00020112
Gregorio T. Obrador
*Universidad Panamericana School of Medicine, Mexico City, Mexico, and
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Iain C. Macdougall
†Department of Renal Medicine, King’s College Hospital, London, United Kingdom
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Summary

Red cell transfusions, erythropoiesis-stimulating agents (ESAs), and intravenous iron therapy all have a place in the treatment of anemia associated with CKD. Their relative merits and uses are subject to many clinical and nonclinical factors. New concerns associated with the use of ESA therapy make it likely that the use of blood transfusions will increase, refueling previous debates about their associated risks. Data on whether red cell transfusions increase sensitization to HLA antigens, rendering subsequent transplantation more problematic, are mainly derived from older literature. Older data suggested that women were more at risk of HLA sensitization than men, particularly those with previous multiple pregnancies, although recent U.S. Renal Data System data have challenged this. HLA sensitization prolongs the waiting time for transplantation and reduces graft survival. Leukocyte depletion of red cells does not appear to reduce the risk of HLA sensitization. This review summarizes much of the data on these issues, as well as highlighting the need for further research on the potential risks for blood transfusion in patients with CKD.

  • Copyright © 2013 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 8 (5)
Clinical Journal of the American Society of Nephrology
Vol. 8, Issue 5
May 07, 2013
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Effect of Red Cell Transfusions on Future Kidney Transplantation
Gregorio T. Obrador, Iain C. Macdougall
CJASN May 2013, 8 (5) 852-860; DOI: 10.2215/CJN.00020112

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Effect of Red Cell Transfusions on Future Kidney Transplantation
Gregorio T. Obrador, Iain C. Macdougall
CJASN May 2013, 8 (5) 852-860; DOI: 10.2215/CJN.00020112
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  • Article
    • Summary
    • Introduction
    • Overview of Blood Transfusion Use in Patients with CKD
    • Evidence for Blood Transfusions Causing Increased HLA Sensitization
    • Effect of Leukocyte Depletion on Risk of HLA Sensitization after Blood Transfusion
    • Effect of Increased HLA Sensitization on Waiting Time for Transplantation
    • Effect of HLA Sensitization on Outcomes after Renal Transplantation
    • Conclusions and Recommendations
    • Disclosures
    • Footnotes
    • References
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More in this TOC Section

  • Assessing Physical Function and Physical Activity in Patients with CKD
  • Management of Crush Victims in Mass Disasters: Highlights from Recently Published Recommendations
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Cited By...

  • Oral Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat (FG-4592) for the Treatment of Anemia in Patients with CKD
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