Prevention of donor-specific T-cell unresponsiveness after buffy-coat-depleted blood transfusion.
The immunosuppressive effect of blood transfusions has been demonstrated in several clinical studies. The effect is probably mediated by HLA-class-II-bearing donor leucocytes, because results from laboratory tests show specific down-regulation of the recipient's T-Cell response after administration of blood from donors sharing one HLA haplotype with the recipient. In the present study we evaluated the immunosuppressive potential of buffy-coat-depleted red cell transfusions in patients waiting for renal transplantation, by measuring the frequency of cytotoxic precursor T cells before and after transfusion. The buffy coat was removed from whole blood by the Optipress system and resulted in > 97% depletion of lymphocytes and monocytes. A single transfusion of HLA-haplotype-matched buffy-coat-depleted red cells induced donor-specific down-regulation of T-cell responses in only two of 14 patients. Since HLA-class-II-bearing cells are also involved in the induction of anti-HLA antibodies, we evaluated retrospectively the incident of HLA alloimmunization after a single transfusion of buffy-coat-depleted red cells. No anti-HLA antibodies were found in 140 patients at risk for primary immunization. We conclude that the poor immunological responses found after a single transfusion of HLA-haplotype-matched buffy-coat-depleted red cells is due to the small number of residual HLA-class-II-bearing donor cells. This blood component should not be used for induction of immunosuppression.
van Prooijen
H C
HC
Department of Haematology, University Hospital Utrecht, The Netherlands.
Aarts-Riemens
M I
MI
van Oostendorp
W R
WR
Hené
R J
RJ
Gmelig-Meyling
F H
FH
de Weger
R A
RA
D002469:Cell Separation; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006681:HLA-D Antigens / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D007958:Leukocyte Count; D007962:Leukocytes / Q000276:immunology; D008297:Male; D012189:Retrospective Studies; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*
D006681:HLA-D Antigens