Effect of Red Cell Transfusions on Future Kidney... : Clinical Journal of the American Society of Nephrology (original) (raw)
In-Depth Reviews
Effect of Red Cell Transfusions on Future Kidney Transplantation
*Universidad Panamericana School of Medicine, Mexico City, Mexico, and
†Department of Renal Medicine, King’s College Hospital, London, United Kingdom
Correspondence: Prof. Iain C. Macdougall, Department of Renal Medicine, King’s College Hospital, London SE5 9RS, United Kingdom. Email: [email protected]
Clinical Journal of the American Society of Nephrology 8(5):p 852-860, May 2013. | DOI: 10.2215/CJN.00020112
Abstract
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 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
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