HLA-DR Matched Transfusions: Development of Donor-Specific T- And B-cell Antibodies and Renal Allograft Outcome

Transplantation. 1999 Apr 15;67(7):1029-35. doi: 10.1097/00007890-199904150-00016.

Abstract

Background: Pretransplant blood transfusions are reported to decrease acute rejection rate and increase graft survival after renal transplantation. This has been attributed to matching for HLA-DR with the transfusion donor, which also results in a lower rate of sensitization.

Methods: The development of donor-specific T- and B-cell antibodies was measured by National Institutes of Health and two-color fluorescence assays after one transfusion in 247 naive patients. Auto-cross-matches were performed to exclude autoantibodies. Patients were grouped according to DR-matching (n=107) or nonmatching (n=140) with the transfusion donor. In 103 renal allograft recipients, acute rejection rate and graft survival were analyzed by Cox regression.

Results: T-cell antibodies developed in 6.5% of the patients. There was no difference between the DR-matched and nonmatched group. No auto-antibodies against T-cells developed, whereas one quarter of the sera had a positive B-cell auto-cross-match. There was no difference with regard to B-cell antibodies (auto-antibody-positive sera excluded) between the DR-matched (15.8%) and nonmatched (18.6%) group. Sharing of HLA A and/or B antigens did not result in a lower frequency of donor-directed T- or B-cell antibodies. None of the risk factors, including DR sharing with transfusion donor, contributed significantly towards graft survival (odds ratio for DR sharing: 1.02; 95% confidence interval: 0.45-2.32; P=0.97). DR sharing was no risk factor towards acute rejection either, in contrast to DR mismatch with kidney donor (odds ratio: 2.9), and use of cyclosporine versus tacrolimus (odds ratio: 4.4).

Conclusions: Development of donor-directed T-cell antibodies after one transfusion of leukocyte-poor blood is low and irrespective of HLA-DR match with transfusion donor. B-cell antibodies develop more frequently and independent of HLA-DR match. In 26% of the sera, B-cell auto-antibodies are detected. Rejection rate and graft survival are not significantly different between HLA-DR-matched and nonmatched transfusions.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies / analysis
  • B-Lymphocytes / immunology
  • Blood Transfusion*
  • Cohort Studies
  • Female
  • Graft Survival / physiology
  • HLA-DR Antigens / analysis*
  • Histocompatibility Testing*
  • Humans
  • Kidney Transplantation / immunology*
  • Male
  • Middle Aged
  • Preoperative Care*
  • Survival Analysis
  • T-Lymphocytes / immunology
  • Tissue Donors
  • Treatment Outcome

Substances

  • Antibodies
  • HLA-DR Antigens