Impact of Early Blood Transfusion After Kidney Transplantation on the Incidence of Donor‐Specific Anti‐HLA Antibodies

• Published in: American journal of transplantation Vol. 16; no. 9; pp. 2661 - 2669
• Main Authors: Ferrandiz, I., Congy‐Jolivet, N., Del Bello, A., Debiol, B., Trébern‐Launay, K., Esposito, L., Milongo, D., Dörr, G., Rostaing, L., Kamar, N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-09-2016; Elsevier
• Subjects: ABO system; alloantibody; Antibodies; Blood; Blood transfusion; Blood transfusions; calcineurin inhibitor: tacrolimus; Case-Control Studies; clinical research/practice; Cyclosporin A; Erythrocyte Transfusion - adverse effects; Erythrocytes; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft rejection; Graft Rejection - epidemiology; Graft Rejection - etiology; Graft Survival; Histocompatibility antigen HLA; HLA Antigens - immunology; Human health and pathology; Humans; Immunoglobulins; Immunology; immunosuppressant; Incidence; Isoantibodies - blood; Isoantibodies - immunology; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney transplantation; Kidney Transplantation - adverse effects; kidney transplantation/nephrology; Kidney transplants; Life Sciences; Male; Middle Aged; Prognosis; Risk Factors; Tacrolimus; Tissue Donors; transfusion; Transplants & implants; alloantibody; immunosuppressant; transfusion; calcineurin inhibitor: tacrolimus; clinical research/practice; kidney transplantation/nephrology
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13795

Little is known about the impact of posttransplant blood transfusion on the sensitization of anti‐HLA antibodies and the formation of donor‐specific antibodies (DSAs). The aims of our study were to determine the 1‐year incidence of DSAs (assessed using a solid‐phase assay) and antibody‐mediated rejection (AMR) in kidney transplant patients who had or had not received a blood transfusion during the first year after transplantation. Included were 390 non–HLA‐sensitized patients who had received an ABO‐compatible kidney transplant and had not previously or simultaneously received a nonkidney transplant. Overall, 64% of patients received a red blood cell transfusion within the first year after transplantation, most within the first month. The overall 1‐year incidence of DSAs was significantly higher in patients that had undergone transfusion (7.2% vs. 0.7% in patients with no transfusion, p < 0.0001). AMR occurred more often in the transfusion group (n = 15, 6%) compared with the nontransfusion group (n = 2, 1.4%; p = 0.04). Blood transfusion was an independent predictive factor for de novo DSA formation but not for AMR. Patients who had a transfusion and developed DSAs were more often treated with cyclosporin A (n = 10, 55.5%) rather than tacrolimus (n = 45, 19.4%; p = 0.0001). In conclusion, early posttransplant blood transfusion may increase immunological risk, especially in underimmunosuppressed patients.
The authors assess the impact of posttransplant blood transfusion on the incidence of donor‐specific antibodies after kidney transplantation and find it may increase immunological risk, especially in underimmunosuppressed patients.