The transfusion effect.
Pretransplant Transfusion 1. With cyclosporine, cadaver kidney donor transplant recipients who had no transfusions (392 patients) had a 66% one-year graft survival rate compared with 77% for those who had transfusions (2916 patients, p less than 0.001). Without cyclosporine, the comparable figures were 57% for those without transfusions (234 patients) compared with 64% for those who had transfusions (2761 patients, p less than 0.05). Thus, the transfusion effect remains a significant factor in transplantation even with the advent of cyclosporine. 2. With cyclosporine, whole blood transfusions effectively increased the survival rate to 96% for one year with more than five transfusions in 26 patients. 3. The transfusion effect was most apparent in patients ages 16 to 40. Older patients had a high survival rate without transfusions. 4. The transfusion effect acted independently from cyclosporine and HLA-B,DR matching. Thus, when all three factors were maximized, there was an 89% one-year survival rate (118 patients) compared with 49% survival when all three factors were at their worst. 5. In transplants performed in 1982 and 1983, the transfusion effect had almost disappeared because the nontransfused patients had a high survival rate. However, in transplants performed in 1984 and 1985, there was a transfusion effect, although not as strong as it was earlier. 6. Second cadaver grafts were improved by intervening transfusions given after rejection of a first graft. Interestingly, more than 10 transfusions yielded a one-year graft survival rate of 69% in 183 patients. 7. The related donor transplant survival rate was significantly influenced by the number of transfusions both in cyclosporine-treated and conventionally treated patients. Peroperative Transfusions at Surgery 8. Peroperative transfusions were most effective in regrafted patients (55% one-year survival rate without and 61% with peroperative transfusions). In first grafts, particularly in males, they were slightly deleterious. These relationships were the same in cyclosporine-treated patients. 9. Peroperative transfusions were beneficial to regrafted patients regardless of their presensitization status, sex, or whether they had rejected their first grafts rapidly or slowly. 10. Second graft survival increased to 77% at one year in 107 patients by adding peroperative transfusions to more than 10 intervening transfusions. 11. One or two units of blood were equivalent, as were the various types of blood products. Whole blood was the most effective, although the numbers of cases available for analysis were small.(ABSTRACT TRUNCATED AT 400 WORDS)
Tokunaga
K
K
Terasaki
P I
PI
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D003524:Cyclosporins / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D008297:Male; D012042:Registries
D003524:Cyclosporins