title: Evidence that the difference in kidney graft survival in DRw6+ and DRw6- recipients may be explained by a blood transfusion policy that is disadvantageous for DRw6+ recipients.
abstract: Kidneys transplanted to HLA-DRw6+ recipients have been shown to have an inferior graft survival compared with DRw6- patients. Because pretransplant blood transfusions influence kidney graft survival, we investigated whether the number of blood transfusions contributes to the observed poor graft survival in DRw6+ patients. We have found that the difference in graft survival in DRw6+ and DRw6- recipients may be explained by a blood transfusion policy that is disadvantageous for DRw6+ recipients. Thus, graft survival in DRw6+ recipients was excellent for those who had received only a single transfusion. More transfusions resulted in a gradual decrease in graft survival. When the number of transfusions exceeded 5, graft survival improved again. By contrast, DRw6- recipients showed an improvement in graft survival with an increasing number of transfusions. DRw6+ recipients therefore display inferior graft survival only when they receive 3-5 transfusions. This finding provides a possible explanation as to why the "DRw6 effect" is a controversial issue, and it suggests that DRw6+ recipients should be given a different pre-transplant transfusion protocol than DRw6- patients.
authors.affiliation: Department of Immunohaematology, University Hospital, Leiden, The Netherlands.
authors.forename: E L
authors.initials: EL
authors.lastname: Lagaaij
authors.forename: G G
authors.initials: GG
authors.lastname: Persijn
authors.forename: A
authors.initials: A
authors.lastname: Termijtelen
authors.forename: G F
authors.initials: GF
authors.lastname: Hendricks
authors.forename: P
authors.initials: P
authors.lastname: de Lange
authors.forename: J J
authors.initials: JJ
authors.lastname: van Rood
mesh_terms: D003524:Cyclosporins / Q000627:therapeutic use; D006082:Graft Enhancement, Immunologic / Q000009:adverse effects; D006085:Graft Survival / Q000187:drug effects; D006681:HLA-D Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D015808:HLA-DR6 Antigen; D006648:Histocompatibility; D006801:Humans; D007114:Immunization; D016030:Kidney Transplantation; D011379:Prognosis; D065227:Transfusion Reaction
chemical_list: D003524:Cyclosporins; D006681:HLA-D Antigens; D006684:HLA-DR Antigens; D015808:HLA-DR6 Antigen