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NDT Advance Access originally published online on May 27, 2009
Nephrology Dialysis Transplantation 2009 24(8):2559-2566; doi:10.1093/ndt/gfp233
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study

Jeroen Aalten1, Frederike J. Bemelman2, Ella M. van den Berg-Loonen3, Frans H. Claas4, Maarten H. Christiaans5, Johan W. de Fijter6, Bouke G. Hepkema7, Ronald J. Hené8, Jaap J. Homan van der Heide9, Johannes P. van Hooff5, Neubury M. Lardy10, Simon P. Lems7, Henderikus G. Otten11, Willem Weimar12, Wil A. Allebes13 and Andries J. Hoitsma1

1 Department of Nephrology, University Medical Center Radboud, Postbus 9101, 6500 HB Nijmegen 2 Department of Nephrology, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam 3 Tissue Typing Laboratory, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht 4 Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden 5 Department of Nephrology, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht 6 Department of Nephrology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden 7 Transplantation Immunology, University Medical Center Groningen, Postbus 30001, 9700 RB Groningen 8 Department of Nephrology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht 9 Department of Nephrology, University Medical Center Groningen, Postbus 30001, 9700 RB Groningen 10 Department of HLA Diagnostics, Sanquin, Postbus 9892, 1006 AN, Amsterdam 11 Department of Immunology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht 12 Department of Nephrology, Erasmus University Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam 13 Department of Blood Transfusion and Transplantation Immunology, University Medical Center Radboud Nijmegen, Postbus 9101 6500 HB Nijmegen, The Netherlands

Correspondence and offprint requests to: Jeroen Aalten; E-mail: j.aalten{at}nier.umcn.nl



  Abstract

Background. 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.

Methods. 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.

Results. 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)].

Conclusions. 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.

Keywords: acute rejection; graft survival; kidney; pre-transplant blood transfusion; sensitization

Received for publication: 22. 2.09
Accepted in revised form: 28. 4.09


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