Naslov
Clinical Relevance of pre-transplant blood transfusions in kidney transplant recipients

Autori
Lukežić, Nataša ; Katalinić, Nataša ; Vukelić- Damijani, Nada ; Starčević, Alma ; Balen, Sanja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Vox Sanguinis / - , 2017, 294-294

Skup
27th Regional Congress of the ISBT

Mjesto i datum
Kopenhagen, Danska, 17.06.2017. - 21.06.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
HLA antibodies, Blood transfusion, Luminex

Sažetak
Background: Alloantibodies against human leukocyte antigens (HLA) represent an important immunological barieer to successful organ transplantation. HLA alloimmunization is caused by exposure to various sensitizing factors such as blood transfusions, pregnancy and/or organ transplantation. Of the three, the main potentially modifiable factor are blood transfusions. Aim: The aim of this study is to asses the frequency of exposure to pre- transplant blood transfusions and evaluate their effect on HLA alloimmunization in kidney transplant recipients using two different HLA antibody screening techniques: complement- dependent cytotoxicity (CDC) and Luminex. Methods: This is a retrospective study that included HLA antibody screening results of kidney recipients transplanted in Clinical Hospital Centre Rijeka from March 2012 until the end of December 2015. The screening of HLA antibodies has been performed periodically every three months, four times per year by CDC and more sensitive Luminex assays in parallel. Informations on blood transfusions were obtained from patients, their nephrologists and medical records. Results: Of total 118 kidney recipients, pre-transplant transfusions received 59 (50%) patients, 37 (31.36%) male and 22 (18.45%) female. At least one red blood cell unit received 35 patients (29.67%). To the combination of previous transfusions and pregnancies were exposed 17 (14.41%) women, transfusions and transplants five (4.23%) recipients and two (1.69%) patients experienced all three sensitizing events. Almost all transfused patients have received red blood cells concentrates (with or without leukocyte reduction) before registration on the waiting list. While being on the waiting list only four (3.39%) patients were transfused, one for the first time. All of them have received leukoreduced blood products. Control group represent 32 patients who were not exposed to any known sensitizing event. Pre-transplant sera of 40 (67.80%) transfused patients were negative. HLA antibodies were detected in 7 (11.86%) patients by CDC and Luminex (CDC+LUM+) and in additional 12 (20.34%) by Luminex only (CDC-LUM+). According to the technique, the difference between the number of patients with HLA antibodies detected by CDC and Luminex technique is not statistically significant. However, the risk of developing HLA antibodies after exposure to blood transfusions is statistically significant when combined with other sensitizing events (OR: 3.325 ; 95% CI 1.020-10.837 ; P=0.046). Also, the allograft and patient survival in this group of kidney transplant recipients was significantly lower compared with control group (P=0.0237). Summary/Conclusion: Pre-transplant blood transfusions are the most frequent sensitizing factor in patients on kidney waiting list. In combination with previous pregnancy and/or transplantation, transfusions represent significant immunogenic stimulus. In relation to CDC, Luminex is more sensitive and specific technique in HLA antibody detection revealing higher number of sensitizing patients although difference is not statistically significant. While patients on the waiting list in Clinical Hospital Centre Rijeka were minimally exposed to blood transfusions, almost all transfused patients received red blood cell concentrates before becoming a registered transplant candidates. Due to detrimental effect of HLA immunization on graft survival and transplant outcome, avoidance of transfusions whenever is possible still remains the key strategy in clinical management of transplant candidate.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA