Perioperative blood transfusion may not increase the risk for acute rejection, graft loss, or death in non-sensitized kidney transplant recipients receiving maintenance immunosuppressive therapy.

In a study of 273 patients free from HLA sensitization who underwent their first kidney transplant, 127 (47%) received a blood transfusion within 30 days, including 33 receiving only an intraoperative transfusion, 69 receiving only a postoperative transfusion, and 25 receiving both. The composite primary outcome of acute rejection, graft loss, or death within the first 12 months differed significantly between patients who did or did not receive blood products in an unadjusted model (20.5% vs 7.5%), but the difference became nonsignificant after inverse probability of treatment weighting, Reem Daloul, MD, of the Ohio State University Medical Center in Columbus, Ohio, and colleagues reported in Kidney International Reports. The cumulative incidence of de novo donor specific antibodies (DSA) during the first year of transplant appeared similar between groups (12.8% transfusion vs 10.9% no transfusion). However, DSA screening was for cause rather than mandated.

The vast majority (97%) of studied patients received lymphocyte depletion induction therapy using thymoglobulin or alemtuzumab, the investigators reported. Individuals in the transfusion group were more likely to be older, have received a deceased donor kidney, and have received induction with the interleukin-2 receptor antagonist basiliximab. Steroids were withdrawn within 7 days, unless otherwise indicated. Maintenance immunosuppression involved variable dual immunosuppressive therapies including calcineurin inhibitors, mammalian target of rapamycin inhibitors, antimetabolites, and/or belatacept therapy.

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“Despite increased exposure to non-self HLA antigen on blood products, our study supports the notion that the risk for alloimmunization related to blood transfusion in the early perioperative period is probably small when lymphocyte depletion and modern immunosuppression maintenance regimens are utilized,” according to Dr Daloul’s team.


Daloul R, Braga JR, Diez A, Logan A, Pesavento T. Early post-transplant blood transfusion and risk for worse graft outcomes. Published January 21, 2021. Kidney Int Rep. doi:10.1016/j.ekir.2020.12.038