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Kidney Week

Abstract: FR-PO041

Postoperative Blood Transfusion Predicts AKI in Patients with Rectal Cancer

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ryu, Ji Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Paek, Jin hyuk, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

Preoperative anemia and perioperative transfusion are associated with postoperative acute kidney injury in cardiovascular surgery, but little is known about their relationship in patients with rectal cancer surgery. Thus, we investigated whether postoperative blood transfusion may predict postoperative acute kidney injury in patients with rectal cancer.

Methods

We collected 1328 patients who underwent rectal cancer surgery from a single-center prospective cohort between 2003 and 2017. Postoperative acute kidney injury (AKI) was determined according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification.

Results

Among 1328 patients, 134 patients (10.1%) received blood transfusions and 1194 patients (89.9%) did not receive. American Society of Anesthesiologists (ASA) score (p < 0.001), preoperative hemoglobin (p < 0.001), albumin, operation time (p < 0.001), amount of intraoperative bleeding (p < 0.001) showed differences in the two groups. Overall AKI incidence was 12.6% and severe AKI incidence was 1.2%. The incidence of postoperative AKI in the transfused group was significantly higher than in no blood transfusions group (10.2% vs 2.3%, p < 0.001, respectively) and similar result was observed in severe AKI (1.1% vs 0.4%, p=0.007, respectively). Cox proportional hazard models revealed that the AKI incidence was different according to preoperative hemoglobin concentration (HR, 0.894; 95% 0.827-0.968; p=0.05) and transfusions (HR, 2.692; 95% 1.822-3.976; p < 0.001). But, there was no difference in perioperative changes in hemoglobin. Two of category of preoperative hemoglobin concentrations (>12 and 10.1-12.0) were associated with a risk of postoperative AKI, whether patients was received transfusions or not (OR, 3.676; 95% 1.703-7.933; p=0.01 and OR, 2.589; 95% 1.209-5.545; p=0.014, respectively).

Conclusion

This study showed that postoperative blood transfusions may increase postoperative AKI in patients with rectal cancer. It is also possible that close monitoring of blood transfusions after surgery may improve AKI outcomes in patients with rectal cancer.