Improving post-operative outcomes for young kidney transplant patients

01 August 2018

A recent study published in Paediatric Nephrology has shown that children who receive a kidney transplant are more likely to need a blood transfusion following surgery if they have low pre-transplant haemoglobin levels.

Blood transfusions following a transplant can cause adverse reactions, including increasing the chance of rejection of the donor kidney, stimulated by an immune response to donor blood. However, they are often needed to counter-act severe anaemia that can occur after this major surgery.

The study, which was conducted by clinicians and researchers at Sydney Children’s Hospital, Randwick and the School of Women’s and Children’s Health, UNSW Sydney, therefore aimed to identify factors that might predict the need for a blood transfusion, and suggest potential strategies to reduce this.

By analysing the age, size, sex and haemoglobin levels of 42 children who had undergone kidney transplants at the Hospital between 2010 and 2017, researchers found that pre-transplant haemoglobin was a predictor for transfusion. 

“The importance of our findings is that unlike other variables like age or weight, pre-transplant haemoglobin levels are potentially modifiable,” said Dr Sean Kennedy, Head of Paediatric Nephrology at Sydney Children’s Hospital and the School of Women’s & Children's Health, UNSW Sydney.

“If we can optimise the management of anaemia in children before they receive a donor kidney, we can potentially reduce their need for a blood transfusion, improve the long term function of the kidney and limit the risks for these already sick children. Up to now, there are no guidelines about the optimal haemoglobin level to target before transplant. Our findings give us an idea about what that target should be.”

The study also highlights the important differences between adult and paediatric medicine.  One potential strategy to improve pre-transplantation haemoglobin levels in children would be to increase the dosage of erythropoietin-stimulating agents (ESA), as eryrthopoietin promotes the formation of red blood cells. While this approach has been linked to negative effects in adults, these were often associated with adult comorbidities such as coronary heart disease and type 2 diabetes, which are rarely seen in children.

The proposed strategy will need to be monitored carefully and tested for safety and efficacy, but it offers a potential strategy to decrease the rejection of donor kidneys and improve health outcomes for kids with chronic kidney disease.

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