SYSTEMATIC TRANSFUSION IN HEMODIALYZED PATIENTS AWAITING GRAFTS

Abstract

Since June 1977, a systematic blood transfusion (BT) policy (160 ml of leukocyte-poor washed erythrocytes given every 6 mo.) was applied to 126 hemodialyzed patients awaiting a 1st kidney graft. Only patients who had anti-T or B lymphocyte (T or BLY) antibodies (Ab) killing fewer than 10 or 20% of the panel cells, respectively, entered the protocol. Screening of anti-T and BLY was performed 8, 15 and 21 days after each BT. Patients were removed from fhe protocol if they developed Ab against > 10 or 20% of the T or BLY panel cells. The cumulative immunization (all Ab types) averaged 90% after 4 BT. Anti-BLY (63%) were more frequent than anti-TLY (49%) after 4 BT. No anti-HLA-DR specificity could be attributed to the anti-BLY; 20% of the anti-TLY displayed a particular anti-HLA-A,B specificity. Patients that had had BT or pregnancies before entering the protocol had a higher immunization degree. The kinetics of the anti-B or TLY pattern differed greatly at the level of their detection after 8, 15 and 21 days following 1 BT and in their development after repeated BT. Some 43 patients received transplants at various stages of the protocol. Recipients grafted without Ab had the best graft outcome (87 vs. 66 actuarial percentage at 3 mo.), even though their HLA (A,B and DR) matching was inferior. There was no significant difference in recipients who had different subgroups of Ab. Apparently, immunization is very high, even after a few BT, when careful controls are performed and BT do not act via active enhancement.