Scholarlink

Background <p>Perioperative red blood cell transfusion (RBCT) and immunosuppressive therapy are critical factors influencing the risk of kidney transplantation (KT) rejection. In this study, we examined how RBCT volume, timing, and immunosuppressive therapy affect biopsy-proven rejection (BPR).</p> Methods <p>We analyzed 170 living donor KT recipients, assessing RBCT timing, volume, immunosuppressive therapy, and recipient characteristics. RBCT timing was classified as none, within 1&#xa0;month, or over 1&#xa0;month post-KT. Random forest and SHapley Additive explanation (SHAP) were used to identify risk factors for BPR. To mitigate overlearning, tenfold cross-validation was performed.</p> Results <p>The calcineurin inhibitor type was the most significant risk factor for BPR, with tacrolimus use associated with a lower risk than cyclosporine use. An RBCT exceeding 6 units and an RBCT administered more than 1&#xa0;month post-KT were identified as critical thresholds for BPR risk. SHAP analysis indicated a nonlinear relationship between pre-transplant hemoglobin levels and BPR risk. RBCT timing and volume significantly influenced BPR risk. Late RBCT and those exceeding 6 units were linked to increased BPR risk. Additionally, tacrolimus may offer superior immunosuppressive control compared with that of cyclosporine regarding BPR. Stratified analysis using SHAP value showed that the high-risk group had significantly lower death-censored graft survival than the low-risk group.</p> Conclusion <p>RBCT volume and timing impact the rejection risk, with an increased risk observed for more than 6 units and over 1&#xa0;month post-KT. Proper immunosuppressive management is crucial and warrants further research.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Impact of red blood cell transfusion timing and volume on biopsy-proven rejection: a single-center cohort study

  • 期刊论文

  • 发表日期：

    2025年9月15日

查看全文
  • Kuniaki Inoue,
  • Shunta Hori,
  • Mitsuru Tomizawa,
  • Tatsuo Yoneda,
  • Yasushi Nakai,
  • Makito Miyake,
  • Nobumichi Tanaka,
  • Kiyohide Fujimoto

摘要

Background

Perioperative red blood cell transfusion (RBCT) and immunosuppressive therapy are critical factors influencing the risk of kidney transplantation (KT) rejection. In this study, we examined how RBCT volume, timing, and immunosuppressive therapy affect biopsy-proven rejection (BPR).

Methods

We analyzed 170 living donor KT recipients, assessing RBCT timing, volume, immunosuppressive therapy, and recipient characteristics. RBCT timing was classified as none, within 1 month, or over 1 month post-KT. Random forest and SHapley Additive explanation (SHAP) were used to identify risk factors for BPR. To mitigate overlearning, tenfold cross-validation was performed.

Results

The calcineurin inhibitor type was the most significant risk factor for BPR, with tacrolimus use associated with a lower risk than cyclosporine use. An RBCT exceeding 6 units and an RBCT administered more than 1 month post-KT were identified as critical thresholds for BPR risk. SHAP analysis indicated a nonlinear relationship between pre-transplant hemoglobin levels and BPR risk. RBCT timing and volume significantly influenced BPR risk. Late RBCT and those exceeding 6 units were linked to increased BPR risk. Additionally, tacrolimus may offer superior immunosuppressive control compared with that of cyclosporine regarding BPR. Stratified analysis using SHAP value showed that the high-risk group had significantly lower death-censored graft survival than the low-risk group.

Conclusion

RBCT volume and timing impact the rejection risk, with an increased risk observed for more than 6 units and over 1 month post-KT. Proper immunosuppressive management is crucial and warrants further research.