Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study.
BACKGROUND
Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome.


METHODS
Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group.


RESULTS
In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)].


CONCLUSIONS
A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.
Aalten
Jeroen
J
Department of Nephrology, University Medical Center Radboud, Postbus 9101, 6500 HB Nijmegen, The Netherlands. j.aalten@nier.umcn.nl
Bemelman
Frederike J
FJ
van den Berg-Loonen
Ella M
EM
Claas
Frans H
FH
Christiaans
Maarten H
MH
de Fijter
Johan W
JW
Hepkema
Bouke G
BG
Hené
Ronald J
RJ
van der Heide
Jaap J Homan
JJ
van Hooff
Johannes P
JP
Lardy
Neubury M
NM
Lems
Simon P
SP
Otten
Henderikus G
HG
Weimar
Willem
W
Allebes
Wil A
WA
Hoitsma
Andries J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens