BLOOD TRANSFUSIONS, CYTOTOXIC ANTIBODIES, AND KIDNEY GRAFT SURVIVAL PRELIMINARY RESULTS OF A SYSTEMATIC TRANSFUSION PROTOCOL

Abstract

Since pretransplant blood transfusions prolong the survival of kidney grafts, a new transfusion policy was started in the frame of Swisstransplant. Before surgery all patients receive at least 2 and, if possible, 5 transfusions (whole blood or packed red blood cells). The present study included 101 recipients of primary cadaver grafts. Of these, 41 were transfused regularly according to the new protocol, 46 had irregular transfusions because of therapeutic necessity and 14 had no transfusion before grafting. The 1 yr survival rate in pretransfused patients was over 70% as compared to 45% in the nontransfused group. There was no significant association with the number of transfusions, but a slight improvement in graft survival was seen in patients deliberately transfused when compared with those transfused because of severe anemia. A delay of more than 3 mo. between the last transfusion and transplantation significantly decreased graft survival at 6 mo. (84 vs 58%; P < 0.02). The occurrence of cytotoxic antibodies, antiperipheral blood lymphocytes (PBL) and anti-B [bone marrow-derived] cell antibodies, was investigated in relation to the number of transfusions received. Broad-spectrum anti-PBL antibodies (> 50% of random panel) were found in 5 of 74 patients transfused according to the protocol (7%) and in 15 of 93 patients transfused for severe anemia (16%; P, not significant). Of 71 recipients followed up for 6 mo., 15 (21%) produced anti-PBL antibodies with limited specificity (< 50%), and 4 (6%) produced broad-spectrum antibodies. Anti-B cell antibodies (< 50%) were produced in 21 of 64 patients (33%). Six patients (9%) had broad-spectrum activity. The occurrence of these antibodies was not associated with the number of transfusions received and did not significantly influence the graft survival at 6 mo. The change in transfusion policy seems to have improved graft survival without producing strong presensitization in a prohibitive proportion of the patients on hemodialysis.