title: The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5.
abstract: BACKGROUND
  Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF).
  
  
  METHODS
  Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT.
  
  
  RESULTS
  Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p < 0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused.
  
  
  CONCLUSIONS
  Any BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased.
  
  
  METHODS
  Therapeutic study, level III; epidemiologic/prognostic study, level II.
authors.affiliation: From the Surgical Critical Care Section (J.S.D.L.C., M.B.S., M.C., J.N., S.O., D.J.M.), Portland Veterans Affairs Medical Center; and Department of Surgery (J.S.D.L.C., M.B.S., K.R., J.N., S.O., D.J.M.), Oregon Health & Science University, Portland, Oregon; Department of Surgery (J.R.Z.), University of Texas Medical Branch, Galveston, Texas; Department of Surgery (M.P.), Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: J Salvador
authors.initials: JS
authors.lastname: de la Cruz
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Sally
authors.forename: John R
authors.initials: JR
authors.lastname: Zatarain
authors.forename: Megan
authors.initials: M
authors.lastname: Crutchfield
authors.forename: Katrina
authors.initials: K
authors.lastname: Ramsey
authors.forename: Jamison
authors.initials: J
authors.lastname: Nielsen
authors.forename: Madhukar
authors.initials: M
authors.lastname: Patel
authors.forename: Jodi
authors.initials: J
authors.lastname: Lapidus
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002102:Cadaver; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome