Sunday June 30, 2019 from 07:30 to 09:00
Necessity for routine crossmatch for blood transfusion at the time of renal transplantation: A quality improvement project
Douglas C. Cheung1, Luke F. Reynolds1, Melin Peng1, Michael Ordon1.
1Urology, University of Toronto, Toronto, ON, Canada
Introduction: Routine crossmatch of packed red blood cells (pRBCs) is completed preoperatively at many transplantation centres in Canada. However, rates of blood transfusion vary and the timing of transfusion during the hospital stay is unclear. Furthermore, judicious and medically appropriate resource adjudication remains a concern. Our objective was to determine the incidence of perioperative pRBC transfusion and predictors of transfusion in patients undergoing renal transplantation.
Methods: A retrospective review of all patients undergoing renal transplantation at our institution from January 2013 to May 2016 was performed. Demographic, biochemical, and clinical parameters, including the incidence of perioperative transfusion, were determined. Perioperative transfusion, defined as an intraoperative transfusion or transfusion within two days of surgery, was the primary outcome. Multivariable logistic regression was performed to assess for predictors of perioperative transfusion.
Results: We identified 428 patients during the study period (average age 55 years, 60% male, 72% deceased donor, and 43% blood thinner use). Twenty (4.7%) patients required an intraoperative transfusion with a mean of 3.1 pRBCs per transfusion. Forty (9.3%) patients required transfusion perioperatively with a mean of 2.8 pRBCs per transfusion, with the most common reason for transfusion being a gradual Hb decline over two days (51%). On multivariable regression analysis, lower preoperative Hb (per g/L unit increase odds ratio [OR] 0.92; 0.88–0.95; p<0.01) and female gender (OR 2.76; 1.20–6.73; p=0.02) were associated with perioperative transfusion.
Conclusions: In our retrospective review, intraoperative and perioperative transfusion rates were low, suggesting routine cross-match may not be necessary. Given that only 9.3% of patients required perioperative transfusion within two days, 90.7% of cross-matched blood went unused in our cohort. Preoperative Hb and female gender were associated with increased transfusion.