Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study.

BACKGROUND: Blood transfusion is common during the peri-transplantation period. The incidence of immunological reactions to blood transfusion after kidney tran splantation and their consequences on graft outcomes have not been extensively studied. AIM: To examine the risk of graft rejection and loss in patients who received blood transfusion in the immediate peri-transplantation period. METHODS: We conducted a single-center retrospective cohort study of 105 kidney recipients, among them 54 patients received leukodepleted blood transfusion at our center between January 2017 and March 2020. RESULTS: This study included 105 kidney recipients, of which 80% kidneys were from living-related donors, 14% from living-unrelated donors, and 6% from deceased donors. Living-related donors were mostly first-degree relatives (74.5%), while the rest were second-degree relatives. The patients were divided into transfusion (n = 54) and non-transfusion (n = 51) groups. The average hemoglobin level at which blood transfusion was commenced was 7.4 ± 0.9 mg/dL. There were no differences between the groups in terms of rejection rates, graft loss, or death. During the study period, there was no significant difference in creatinine level progression between the two groups. Delayed graft function was higher in the transfusion group; however, this finding was not statistically significant. A high number of transfused packed red blood cells was significantly associated with increased creatinine levels at the end of the study. CONCLUSION: Leukodepleted blood transfusion was not associated with a higher risk of rejection, graft loss, or death in kidney transplant recipients.

Willingness for Solid-Organ Donation in Saudi Arabia: A Skyscape View.

OBJECTIVES: The number of patients with organ failure in Saudi Arabia is increasing annually, and transplantation offers the best outcome for these patients. However, the number of donors does not meet these needs. MATERIALS AND METHODS: A questionnaire was distri-buted to assess the behavior of participants in Saudi Arabia toward different types of organ donation. The questionnaire examined general willingness to donate, deceased donation, living donation, and refusal to donate, as well as paired-exchange donation and next-of-kin consenting. RESULTS: Of the 1099 participants, most were men (64%) and middle-aged (46%, 31-45 years old), with 36% of participants currently willing to donate or already registered as donors. Although 592 participants (54%) were not yet willing to donate, they believed they could consider making donations in specific circumstances (eg, when a relative is in need). In all circumstances, 10% (n = 108) of the participants refused to donate. With regard to deceased donation, 74% of participants accepted this, but only 29% (n = 322) agreed to consent for donation as next of kin. Of 1099 participants, 143 (13%) were willing to accept altruistic donation. Paired-exchange donation was widely accepted in a cohort study (n = 725, 65%), as opposed to list exchange (n = 540, 49%). Religious beliefs were the main reason behind the refusal of donation in the study cohort (n = 37, 37%). Female participants were less likely to refuse organ donation (odds ratio: 0.562; 95% CI, 0.407-0.775; P < .001), whereas older participants (> 60 years) were more likely to refuse organ donation (odds ratio: 5.457; 95% CI, 1.894-15.722; P = .002). CONCLUSIONS: This study described the willingness of the Saudi population to donate organs in general and under special conditions, such as deceased donation, living-unrelated donation, altruistic donation, paired-exchange donation, list exchange donation, and next-of-kin consent.

Consensus guidelines of cardiovascular risk assessment in kidney transplantation in Saudi Arabia: Review of current practice, evidence, and recommendations.

Screening for cardiovascular (CV) disease before transplant is common. However, the clinical utility of screening asymptomatic transplant candidates remains unclear. There is a large degree of variation among the practices of the different transplant centers in the Kingdom of Saudi Arabia (KSA) and among the international guidelines. Opinions are mostly based on mixed observational data with a great potential for bias. When compared to the Western countries, renal-transplant candidates in the KSA are likely to have longer dialysis vintage, higher prevalence of catheter use, higher rate of uncontrolled hyperparathyroidism, and high prevalence of diabetes. These factors are likely to expose renal-transplant candidates to a higher CV risk than those in Western countries. In the absence of any published guideline for CV risk assessment of the renal-transplant candidate in the KSA, we present these guidelines as the first published guidelines in the KSA. These guidelines review the pertinent aspects from the most recent American College of Cardiology/American Heart Association guidelines for cardiac disease evaluation and management among kidney-transplant candidates and reflect on the local practices in the KSA. These guidelines overview many of the daily- encountered challenges in renal transplantation such as the indications for stress testing, screening coronary angiogram and prophylactic revascularization, screening and management of pulmonary hypertension, cardiac surveillance while on the waiting list and duration of dual-antiplatelet therapy before renal transplant. These guidelines were reviewed by a team of consultant nephrologists, cardiologists, anesthesiologists, and transplant surgeons from six major transplant centers in the KSA. The guidelines aim to standardize the practices of CV risk assessment in kidney transplantation in the KSA, according to the most up-to-date available evidence. The expected impact of these guidelines on the current practices is also reviewed here.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants post-kidney transplantation.

BACKGROUND: Novel oral anticoagulants (NOACs) were developed as alternatives to vitamin K antagonists, primarily warfarin, as they do not require routine monitoring and have limited drug-drug and drug-food interactions. However, the efficacy and safety of these agents in kidney transplantation are not well studied. AIM: To assess the profile and safety of NOACs for patients who had kidney transplantation, and to provide recommendations and guidelines on therapeutic strategies in these patients. METHODS: This was a retrospective study carried out among adult patients who were actively on the following NOACs (apixaban, rivaroxaban or dabigatran) in our renal transplantation program from December 2015 to December 2016. The patients were identified primarily through electronic medical record system (patient data linkage). Data on the clinical and laboratory profile of the patients were retrieved and analyzed with SPSS 22.0. RESULTS: Complete data on 42 renal transplant patients were retrieved: 59.5% males, 90.5% were whites and 66.7% were older than 60 years old. The mean duration since renal transplantation of the patients was 8.8 ± 7.4 years. The most common risk factors for the development of end-stage renal disease in the subjects were hypertension (19.0%), polycystic kidney disease (19.0%), followed by diabetic nephropathy (16.7%) and chronic glomerulonephritis (16.7%). The main indications for NOACs use in the cohort were atrial fibrillation in 25 patients (59.5%) and venous thromboembolism in 10 patients (23.8%). Overall, 29 patients (69%) were treated with apixaban, 10 patients (23.8%) with rivaroxaban and 3 patients (7.14%) with dabigatran. No (0%) thromboembolic events were observed during the one-year period, but 3 (7.1%) bleeding events occurred in the cohort consisting of 1 patient treated with rivaroxaban 15 mg daily and 2 patients who received apixaban 2.5 mg twice daily. There were no significant changes in serum tacrolimus level three days after the initiation of NOACs among patients treated with tacrolimus (pre- and post-NOACs tacrolimus levels were 7.2516 and 7.8867 ng/mL, P = 0.55, respectively). Also, after one-year of treatment with NOACs there were no significant changes in the pre- and post-NOACs serum creatinine level (P = 0.772) and estimated glomerular filtration rates (P = 0.232). CONCLUSION: No thromboembolic events or significant changes in renal profile were observed in our cohort of kidney transplant recipients who were treated with NOACs for at least a year. However, a few bleeding events were observed. This calls for further well-planned randomized controlled trials to assess the efficacy and safety of NOACs among renal transplant recipients.