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

Since pretransplant blood transfusions have been shown to prolong the survival of kidney grafts, a new transfusion policy has been started in the frame of Swisstransplant. Before surgery all patients receive at least two and, if possible, five transfusions (whole blood or packed red blood cells). The present study includes 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-year 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 anaemia. A delay of more than 3 months between the last transfusion and transplantation significantly decreased graft survival at 6 months (84 versus 58%; P < 0.02). The occurrence of cytotoxic antibodies, both antiperipheral blood lymphocytes (PEL) and anti-B 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 anaemia (16%; P, not significant). Of 71 recipients followed up for 6 months, 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 months. The change in transfusion policy seems to have improved graft survival without producing strong presensitization in a prohibitive proportion of the patients on hemodialysis. Many reports have confirmed the observation by Opelz et al. (1) demonstrating the beneficial effect of prior blood transfusions on kidney graft survival (2, 3), but there is still much controversy over the relative merits of the various transfusion policies and the associated risks of sensitization (4, 5). An optimal transfusion policy should aim at achieving a transfusion effect without the risk of hyperimmunization. In Switzerland, two retrospective studies have shown a significant improvement of graft survival in the transfused recipients (6, 7). Consequently, a new transfusion policy was introduced in Switzerland at the end of 1976. The aim of this prospective study is to evaluate the results obtained with this new transfusion policy and to determine the incidence of preformed cytotoxic antibodies and their influence on kidney graft survival. © 1979 by The Williams and Wilkins Co.