Longer red blood cell storage duration is associated with a decreased risk of graft failure among kidney transplant recipients, according to investigators.

In a study of 12,559 patients who underwent their first kidney transplantation, 3483 (27.7%) received a red blood cell transfusion within 14 days. For each additional day of red blood cell storage, the risk for graft failure decreased by 1%, Emilie Gaiffe, PhD, of Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, in Cedex, France, and colleagues reported in JAMA Network Open. A storage time exceeding 20 days was significantly associated with a 5% absolute decrease in graft failure at 3 years and a 7% absolute decrease at 5 years, compared with red blood cell storage less than 20 days.

“The findings in this study show an association between longer [red blood cell] storage duration and improved graft survival. These results may support the use of the oldest [red blood cell units] available for transfusion following kidney transplants,” Dr Gaiffe wrote.

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The team hypothesized that longer stored red blood cells may promote immunomodulation that favors graft survival. Or, to the extent that stored red blood cells still contain white blood cells, longer storage may decrease the likelihood of HLA immunization.

Fresh red blood cell units have higher concentrations of various mediators, including damaged leukocytes and platelets, cell-free DNA, and microvesicles, that may promote inflammation, coagulation, endothelial injury, and organ damage.

The study did not consider all possible contributory factors related to blood donors, such as race and ethnicity, previous pregnancies, or genetic characteristics, which is a limitation.


Gaiffe E, Vernerey D, Bardiaux L, et al. Transfused red blood cell characteristics and kidney transplant outcomes among patients receiving early posttransplant transfusion. JAMA Netw Open. Published online September 14, 2023. doi:10.1001/jamanetworkopen.2023.32821