The Association Between Transfusion of Blood Products and Postoperative Renal Impairment

Abstract Purpose of Review This review summarizes the most recent literature on the association between the administration of blood products with acute kidney injury (AKI). The multifactorial nature of AKI is reviewed and the potential mechanisms for the association are explored. In addition, immunological causes of AKI after transfusion are addressed. We also provide recommendations for transfusion practice and perioperative management to minimize the risk of AKI. Recent Findings Several recent studies have demonstrated a consistent association between the administration of blood products and AKI. Restrictive blood transfusion protocols have however failed to reduce the incidence of AKI. Summary Transfusion of blood products is definitively associated with AKI. Considering current evidence however it is still unknown if there is a cause-and-effect relationship underlying this association. Notwithstanding the uncertainty, blood products should be employed with great caution in patients who are at significant risk of AKI until further evidence becomes available to clarify the situation. The etiology of AKI is multifactorial, and factors other than transfusion may be more important. Intraoperative hypotension must be prevented. The use of drugs which have the potential for renal toxicity like intravenous contrast agents, aminoglycoside antibiotics and non-steroidal analgesic drugs should be minimized. Adequate fluid resuscitation is also necessary to guarantee adequate cardiac output and renal perfusion. Goal-directed fluid management should be considered in high-risk patients. Transfusion of incompatible blood products must also be avoided as at all costs because this can lead to severe AKI.