Prevalence and predictors of early blood transfusion in renal transplant recipients: a retrospective study

Background

Anemia associated with chronic kidney disease is driven by reduced erythropoietin synthesis, chronic inflammation, and decreased red blood cell lifespan. During and after renal transplant surgery, recipients may need blood transfusions. Transfusion rates exhibit significant inter-center variability, largely driven by differing clinical criteria among transplant surgery, nephrology, and intensive care units.

Study design and methods

A retrospective study was conducted of 407 renal transplant recipients who underwent transplantation from May 15, 2023 to August 16, 2025 at the Shahid Dharmabhakta National Transplant Center, Nepal. Early transfusion was defined as any blood product administration occurring within 14 days post-surgery. Clinical and Laboratory variables were compared between transfused and non-transfused patients using either the Mann–Whitney U test or chi-square test as appropriate. Variables significant in univariate analysis were included in multivariate logistic regression to identify predictors of transfusion.

Results

Ninety-five patients (23.34%) required transfusions with leukoreduced red blood cells being the most common blood product. Univariate analysis revealed that preoperative hemoglobin levels, diabetic nephropathy, and the length of hospital stay were significantly associated with transfusion requirements. Multivariate analysis showed that preoperative hemoglobin and length of stay were predictors of transfusion. The hemoglobin nadir for the transfused group reached a mean of 6.3 ± 1.05 g/dL and a median of 6.1 g/dL, with an interquartile range from 4.2 to 10.0 g/dL.

Discussion

The results of this study show that a conservative transfusion approach can be effective in achieving good clinical outcomes, especially in resource limited centers.