title: Sensitization from transfusion in patients awaiting primary kidney transplant.
abstract: BACKGROUND
  Sensitization to human leukocyte antigen (HLA) from red blood cell (RBC) transfusion is poorly quantified and is based on outdated, insensitive methods. The objective was to evaluate the effect of transfusion on the breadth, magnitude and specificity of HLA antibody formation using sensitive and specific methods.
  
  
  METHODS
  Transfusion, demographic and clinical data from the US Renal Data System were obtained for patients on dialysis awaiting primary kidney transplant who had ≥ 2 HLA antibody measurements using the Luminex single-antigen bead assay. One cohort included patients with a transfusion (n = 50) between two antibody measurements matched with up to four nontransfused patients (n = 155) by age, sex, race and vintage (time on dialysis). A second crossover cohort (n = 25) included patients with multiple antibody measurements before and after transfusion. We studied changes in HLA antibody mean fluorescence intensity (MFI) and calculated panel reactive antibody (cPRA).
  
  
  RESULTS
  In the matched cohort, 10 of 50 (20%) transfused versus 6 of 155 (4%) nontransfused patients had a ≥ 10 HLA antibodies increase of >3000 MFI (P = 0.0006); 6 of 50 (12%) transfused patients had a ≥ 30 antibodies increase (P = 0.0007). In the crossover cohort, the number of HLA antibodies increasing >1000 and >3000 MFI was higher in the transfused versus the control period, P = 0.03 and P = 0.008, respectively. Using a ≥ 3000 MFI threshold, cPRA significantly increased in both matched (P = 0.01) and crossover (P = 0.002) transfused patients.
  
  
  CONCLUSIONS
  Among prospective primary kidney transplant recipients, RBC transfusion results in clinically significant increases in HLA antibody strength and breadth, which adversely affect the opportunity for future transplant.
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Yabu
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Anderson
authors.forename: Deborah
authors.initials: D
authors.lastname: Kim
authors.forename: Brian D
authors.initials: BD
authors.lastname: Bradbury
authors.forename: Calvin D
authors.initials: CD
authors.lastname: Lou
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petersen
authors.forename: Jerome
authors.initials: J
authors.lastname: Rossert
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Dolly B
authors.initials: DB
authors.lastname: Tyan
mesh_terms: D000906:Antibodies / Q000097:blood* / Q000276:immunology; D000917:Antibody Formation / Q000276:immunology*; D001803:Blood Transfusion; D018592:Cross-Over Studies; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D014850:Waiting Lists
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: HLA antibody; calculated panel reactive antibody; kidney transplantation; sensitization; transfusion