UNOS Registry data: effect of transfusions.
1. First cadaver White transplant recipients had a 4-5% increase in graft survival associated with transfusions compared with nontransfused recipients (p less than 0.001). The effect, although small, was significant, occurred at 3 months, and was evident at 1 year. This early effect (3 months) was also noted in regraft transplant recipients, living-related recipients, and 1-haplotype match transfused patients. 2. African-American and Hispanic transplant recipients did not show a transfusion effect. Indeed, African-American transplant recipients showed a reverse transfusion effect, which is in contrast to other previously reported UCLA Registry data. 3. The effect of during-transplant transfusions was negligible (ie, a 1% increase in graft survival). Additionally, one-fourth of all recipients had perioperative transfusions. 4. A transfusion effect was not shown within HLA matching for Class I antigens; similarly, little transfusion effect was found within matching groups for Class II antigens. Again, this contrasts with reported UCLA Registry data which indicated that the transfusion effect had a 10-15% difference in graft survival between the non- and transfused individuals in the 2-mismatch HLA Class II antigen group. 5. One of the most important effects on graft survival is donor age, and the preliminary data indicate that transfusions may help graft function in recipients of older donor kidneys. However, there are very few recipients in this older donor category. 6. The incidence of graft rejection was lower in transfused recipients. Additionally, graft rejection episodes remain a very potent indicator of transplant survival. That is, patients having graft rejection at 3 months showed a 20-25% lower 1-year graft survival rate than those without rejection. There were indications that there was less severe graft rejection in transfused patients; however, this could only be shown if graft rejection occurred at discharge and was not evident at 3 months or 6 months posttransplant. 7. SCr was the best indicator of 1-year graft function, even better than the presence or absence of rejection. Lower SCr levels were found in higher frequency in transfused patients. 8. There was a slight increase in graft survival associated with transfusion and PRA in first-transplant recipients, and in the PRA-positive and PRA-negative groups, there was a trend toward lower graft survival for recipients with antibodies. In regrafts, transfused recipients who did not make antibodies had a 5-10% better graft survival than the nontransfused recipients without antibodies. Perhaps this indicates that transplant candidates who did not make cytotoxic antibodies after being transfused were nonresponders.(ABSTRACT TRUNCATED AT 400 WORDS)
Cicciarelli
J
J
D000367:Age Factors; D001803:Blood Transfusion; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D044469:Racial Groups; D012042:Registries; D014481:United States