The Association Between Platelet Transfusion and Acute Kidney Injury Following Fontan Surgery

Objectives: Previous studies have demonstrated an association between transfusion and increased organ dysfunction. We sought to determine the association between transfusion of blood components (red blood cell [RBC], plasma, platelet, and cryoprecipitate transfusions) with development of acute kidney injury (AKI) in children following the Fontan procedure. Methods: This is a single center, retrospective cohort study from 2009 to 2016. All children who underwent the Fontan procedure during the prescribed period who had transfusion and laboratory data available were included. Results: Eighty-eight children were enrolled. The median (interquartile range [IQR]) age was 4.5 (3.3-6.0) years, and median (IQR) weight was 14.8 (13.0-18.8) kg. The median (IQR) cardiopulmonary bypass (CPB) time was 62 (47-89) minutes. Following surgery, according to Kidney Disease Improving Global Outcomes criteria, 41% (36/88) had stage 1 AKI, 23% (20/88) stage 2 AKI, and 15% (13/88) stage 3 AKI. Fifty-eight percent (51/88) of children received at least one RBC transfusion, 73% (64/88) received at least one plasma transfusion, 47% (41/88) received at least one platelet transfusion, and 28% (25/88) received at least one cryoprecipitate transfusion. Children with severe AKI received more of each blood component. After adjusting for age, weight, pre-Fontan pulmonary vascular resistance, pre-Fontan dominant ventricular end-diastolic pressure, CPB time, RBC dose, plasma dose, and cryoprecipitate dose, each 1 mL/kg of platelet transfusion was associated with an increased risk in development of severe AKI (odds ratio: 1.160, 95%CI 1.006-1.339, P = .041). Conclusions: In our cohort of children undergoing the Fontan procedure, platelet transfusion was independently associated with an increased risk of severe AKI postoperatively. The risks, benefits, and alternatives to transfusion should be carefully weighed in this patient population.