engleski

Pre-transplatant blood transfusions and their influence on HLA alloimmunization in kidney transplant recipients

Alloantibodies against human leukocyte antigens (HLA) are one of the major immunological barieer to successful organ transplantation. Exposure to the blood transfusions represents the most frequent and the main potentially modifiable sensitizing factor that may cause HLA alloimmunization. The aim of this study is to determine the frequency of exposure to the pre-transplant blood transfusions in kidney recipients and to assess their effect on HLA alloimmunization. Methods: This retrospective study assesses the results of HLA antibody screening in recipients of the first, cadaveric renal allograft that were transplanted in Clinical Hospital Centre Rijeka between March 2012 and December 2017. HLA antibody screening is performed periodically four times per year by CDC and Luminex based assays in parallel. Information on sensitizing events was obtained from patients, their nephrologists and medical records. Results: A first, cadaveric kidney transplant received 156 patients at our centre, 107 (68.6%) men and 49 (31.4%) women. Blood transfusion was used to correct pre-transplant anaemia in 79 (50.6%) patients, more in men than women (49 vs. 30 ; 62.0% vs. 38.0%). Control group represents 59 patients who were not exposed to any known sensitizing event. Pre-transplant sera of 55 (69.6%) transfused patients were negative. HLA antibodies were detected in 8 (10.1%) patients by CDC and Luminex (CDC+LUM+) and in additional 12 (15.2%) by Luminex only (CDC-LUM+). According to the technique, no statistical difference was observed. The risk of developing HLA antibodies after exposure to blood transfusions is statistically significant (OR: 3.5354 ; 95% CI 1.5468 to 8.0803 ; P=0.003). Also, the allograft survival in transfused kidney transplant recipients was significantly lower compared with the control group (P=0.102). Conclusion: Pre-transplant blood transfusions are the most frequent sensitizing event in kidney allograft recipients representing significant risk factor for HLA alloimmunization. Due to deleterious effect of HLA alloimmunization on graft survival, avoiding transfusions remains the key strategy in clinical management of candidates for kidney transplantation.

Blood transfusion, HLA alloimmunization

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