| Summary: | Background: Patients undergoing kidney transplantation (KT) often receive red blood cell (RBC) transfusion during admission for KT which may increase the risk of allosensitization. The association between peri-transplant RBC transfusion and graft survival was evaluated using a nationwide cohort. Methods: This retrospective study analyzed 13,871 patients who underwent KT in Korea between 2007 and 2015. The outcomes were graft failure rate and overall patient survival depending on the amount of RBC transfusion. Results: The overall graft failure rate was 15.5%. Compared to the graft failure rate of 13.5% in the no transfusion group, the graft failure rate was 15.4% in the 1–2 units group (sHR 1.06 (95% CI 0.97–1.17), <i>p</i> = 0.216), 21.4% in the 3–5 units group (sHR 1.39 (1.21–1.61), <i>p</i> < 0.001), and 35.3% in the 6 or more units group (sHR 2.20 (1.70–2.85), <i>p</i> < 0.001). The overall survival rate was 97.5% in the no transfusion group, compared to 95.9% in the 1–2 units group (HR 1.50 (1.22–1.83), <i>p</i> < 0.001), 92.0% in the 3–5 units group (HR 2.43 (1.87–3.15), <i>p</i> < 0.001), and 67.5% in the 6 or more units group (HR 6.81 (5.03–9.22), <i>p</i> < 0.001). Conclusions: Peri-transplant RBC transfusion was independently associated with the increased risk of renal allograft failure and death in KT patients.
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