TY - JOUR
T1 - Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study
AU - Aalten, Jeroen
AU - Bemelman, Frederike J.
AU - van den Berg-Loonen, Ella M.
AU - Claas, Frans H.
AU - Christiaans, Maarten H.
AU - de Fijter, Johan W.
AU - Hepkema, Bouke G.
AU - Hené, Ronald J.
AU - Homan van der Heide, Jaap J.
AU - van Hooff, Johannes P.
AU - Lardy, Neubury M.
AU - Lems, Simon P.
AU - Otten, Henderikus G.
AU - Weimar, Willem
AU - Allebes, Wil A.
AU - Hoitsma, Andries J.
PY - 2009
Y1 - 2009
N2 - 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. 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. 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)]. 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
AB - 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. 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. 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)]. 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
U2 - https://doi.org/10.1093/ndt/gfp233
DO - https://doi.org/10.1093/ndt/gfp233
M3 - Article
C2 - 19474284
SN - 0931-0509
VL - 24
SP - 2559
EP - 2566
JO - Nephrology, dialysis, transplantation
JF - Nephrology, dialysis, transplantation
IS - 8
ER -