BLOOD TRANSFUSIONS AS PRETREATMENT FOR KIDNEY TRANSPLANTATION

Abstract

A group of 28 untransfused uremic patients was given 5 or more units of stored blood as pretreatment for kidney transplantation; 9 patients formed lymphocytotoxic antibodies against B cells and 1 patient developed multispecific antibodies against B and T cell panels (> 80% reactivity). During the same period 22 previously transfused patients received up to 5 transfusions as pretreatment for kidney transplantation. B cell antibodies were formed by 10 patients, and 4 also formed T cell antibodies, 2 with broad reactivity. Cellular immune reactivity in vitro was studied on frozen cells from 17 randomly chosen patients. After 5 blood transfusions no significant changes were seen in blood lymphocyte responses to phytohemagglutinin, Concanavalin A or in mixed lymphocyte cultures and cell-mediated lympholysis. After transfusion 3 patients got non-A, non-B hepatitis and were withdrawn for up to 6 mo. from the transplantation list because of increased S-ALAT [serum alanine aminotransferase] and S-ASAT [serum aspartate aminotransferase]. Of the 50 patients, 27 have received kidney grafts, 6 of 20 who were sensitized, and 21 of 30 who were nonsensitized. Because of positive crossmatches no patient with multispecific T cell antibodies has received a graft. The transfusion regimen for kidney recipients has rendered barely 1/3 of the patients sensitized (mostly against B cells) and 3 of 50 hypersensitized. No effect of T cell reactivity could be seen following 5 planned transfusions. Because fewer patients with antibodies received grafts (30% with antibodies, compared with 70% without [P < 0.01]) the blood transfusions seem to have led to a selective effect.