Association of blood transfusion with acute kidney injury after transcatheter aortic valve replacement: A meta-analysis

doi:10.5527/wjn.v5.i5.482

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World Journal of Nephrology

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Meta-Analysis

World J Nephrol. Sep 6, 2016; 5(5): 482-488
Published online Sep 6, 2016. doi: 10.5527/wjn.v5.i5.482

Association of blood transfusion with acute kidney injury after transcatheter aortic valve replacement: A meta-analysis

Charat Thongprayoon, Wisit Cheungpasitporn, Erin A Gillaspie, Kevin L Greason, Kianoush B Kashani

Charat Thongprayoon, Wisit Cheungpasitporn, Kianoush B Kashani, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States

Erin A Gillaspie, Kevin L Greason, Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States

Kianoush B Kashani, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States

Author contributions: Thongprayoon C and Cheungpasitporn W contributed equally to this work; Thongprayoon C and Cheungpasitporn W contributed to performing the search, analysis and interpretation of data, analysis of data and final approval of the version to be published; Gillaspie EA contributed to critical revising of the intellectual content and final approval of the version to be published; Greason KL contributed to critical revising of the intellectual content and final approval of the version to be published; Kashani KB contributed to concept and design, critical revising of the intellectual content and final approval of the version to be published.

Conflict-of-interest statement: All authors report no conflicts-of-interest.

Data sharing statement: No additional data are available.

Correspondence to: Kianoush B Kashani, MD, Assistant Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. kashani.kianoush@mayo.edu

Telephone: +1-507-2667093 Fax: +1-507-2667891

Received: March 19, 2016
Peer-review started: March 22, 2016
First decision: April 20, 2016
Revised: April 23, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: September 6, 2016
Processing time: 166 Days and 3.9 Hours

Abstract

AIM

To assess red blood cell (RBC) transfusion effects on acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR).

METHODS

A literature search was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of the databases through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the risks of AKI following TAVR in patients who received periprocedural RBC transfusion were included. Pooled risk ratio (RR) and 95%CI were calculated using a random-effect, generic inverse variance method.

RESULTS

Sixteen cohort studies with 4690 patients were included in the analyses to assess the risk of AKI after TAVR in patients who received a periprocedural RBC transfusion. The pooled RR of AKI after TAVR in patients who received a periprocedural RBC transfusion was 1.95 (95%CI: 1.56-2.43) when compared with the patients who did not receive a RBC transfusion. The meta-analysis was then limited to only studies with adjusted analysis for confounders assessing the risk of AKI after TAVR; the pooled RR of AKI in patients who received periprocedural RBC transfusion was 1.85 (95%CI: 1.29-2.67).

CONCLUSION

Our meta-analysis demonstrates an association between periprocedural RBC transfusion and a higher risk of AKI after TAVR. Future studies are required to assess the risks of severe AKI after TAVR requiring renal replacement therapy and mortality in the patients who received periprocedural RBC transfusion.

Keywords: Acute kidney injury; Transcatheter aortic valve replacement; Meta-analysis; Mortality; Blood transfusion

Core tip: We performed this meta-analysis to assess the impact of periprocedural red blood cell (RBC) transfusion on the risk of acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). We verified a significant association between peri-procedural RBC transfusion and AKI after a TAVR with an overall 1.95-fold increased risk of AKI compared to those who did not receive transfusion. This study highlights the importance of vigilance when considering transfusions and should impact the clinical management of the high-risk group of patients undergoing TAVR.