Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study

Jeroen Aalten; Frederike J. Bemelman; Ella M. van den Berg-Loonen; Frans H. Claas; Maarten H. Christiaans; Johan W. de Fijter; Bouke G. Hepkema; Ronald J. Hene; Jaap J. Homan van der Heide; Johannes P. van Hooff; Neubury M. Lardy; Simon P. Lems; Henderikus G. Otten; Willem Weimar; Wil A. Allebes; Andries J. Hoitsma

doi:10.1093/ndt/gfp233

Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study

Jeroen Aalten^*, Frederike J. Bemelman, Ella M. van den Berg-Loonen, Frans H. Claas, Maarten H. Christiaans, Johan W. de Fijter, Bouke G. Hepkema, Ronald J. Hene, Jaap J. Homan van der Heide, Johannes P. van Hooff, Neubury M. Lardy, Simon P. Lems, Henderikus G. Otten, Willem Weimar, Wil A. Allebes, Andries J. Hoitsma

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

24 Citations (Scopus)

Abstract

Background. Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome.

Methods. Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group.

Results. In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)].

Conclusions. A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.

Original language	English
Pages (from-to)	2559-2566
Number of pages	8
Journal	Nephrology Dialysis Transplantation
Volume	24
Issue number	8
DOIs	https://doi.org/10.1093/ndt/gfp233
Publication status	Published - Aug-2009

Keywords

acute rejection
graft survival
kidney
pre-transplant blood transfusion
sensitization
DONOR-SPECIFIC TRANSFUSIONS
RENAL-ALLOGRAFT RECIPIENTS
REGULATORY T-CELLS
CROSS-MATCH
ACUTE REJECTION
CYCLOSPORINE ERA
GRAFT-SURVIVAL
FLOW-CYTOMETRY
TERM
ANTIBODIES

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Aalten, J., Bemelman, F. J., van den Berg-Loonen, E. M., Claas, F. H., Christiaans, M. H., de Fijter, J. W., Hepkema, B. G., Hene, R. J., van der Heide, J. J. H., van Hooff, J. P., Lardy, N. M., Lems, S. P., Otten, H. G., Weimar, W., Allebes, W. A., & Hoitsma, A. J. (2009). Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study. Nephrology Dialysis Transplantation, 24(8), 2559-2566. https://doi.org/10.1093/ndt/gfp233

@article{ab9c920d106341c6ae5008955b56b803,

title = "Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study",

abstract = "Background. Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome.Methods. Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group.Results. In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)].Conclusions. A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.",

keywords = "acute rejection, graft survival, kidney, pre-transplant blood transfusion, sensitization, DONOR-SPECIFIC TRANSFUSIONS, RENAL-ALLOGRAFT RECIPIENTS, REGULATORY T-CELLS, CROSS-MATCH, ACUTE REJECTION, CYCLOSPORINE ERA, GRAFT-SURVIVAL, FLOW-CYTOMETRY, TERM, ANTIBODIES",

author = "Jeroen Aalten and Bemelman, {Frederike J.} and {van den Berg-Loonen}, {Ella M.} and Claas, {Frans H.} and Christiaans, {Maarten H.} and {de Fijter}, {Johan W.} and Hepkema, {Bouke G.} and Hene, {Ronald J.} and {van der Heide}, {Jaap J. Homan} and {van Hooff}, {Johannes P.} and Lardy, {Neubury M.} and Lems, {Simon P.} and Otten, {Henderikus G.} and Willem Weimar and Allebes, {Wil A.} and Hoitsma, {Andries J.}",

year = "2009",

month = aug,

doi = "10.1093/ndt/gfp233",

language = "English",

volume = "24",

pages = "2559--2566",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "8",

}

Aalten, J, Bemelman, FJ, van den Berg-Loonen, EM, Claas, FH, Christiaans, MH, de Fijter, JW, Hepkema, BG, Hene, RJ, van der Heide, JJH, van Hooff, JP, Lardy, NM, Lems, SP, Otten, HG, Weimar, W, Allebes, WA & Hoitsma, AJ 2009, 'Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study', Nephrology Dialysis Transplantation, vol. 24, no. 8, pp. 2559-2566. https://doi.org/10.1093/ndt/gfp233

TY - JOUR

T1 - Pre-kidney-transplant blood transfusions do not improve transplantation outcome

T2 - a Dutch national study

AU - Aalten, Jeroen

AU - Bemelman, Frederike J.

AU - van den Berg-Loonen, Ella M.

AU - Claas, Frans H.

AU - Christiaans, Maarten H.

AU - de Fijter, Johan W.

AU - Hepkema, Bouke G.

AU - Hene, Ronald J.

AU - van der Heide, Jaap J. Homan

AU - van Hooff, Johannes P.

AU - Lardy, Neubury M.

AU - Lems, Simon P.

AU - Otten, Henderikus G.

AU - Weimar, Willem

AU - Allebes, Wil A.

AU - Hoitsma, Andries J.

PY - 2009/8

Y1 - 2009/8

N2 - Background. Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome.Methods. Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group.Results. In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)].Conclusions. A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.

AB - Background. Female renal transplant candidates are prone to be sensitized by prior pregnancies, and undetected historical sensitization might decrease transplantation outcome. Hypothesis of our study was that pre-transplant blood transfusions (PTFs) can elucidate historical sensitization and that the avoidance of the associated antigens can improve transplantation outcome.Methods. Data from all female non-immunized renal transplant candidates who received a random PTF (rPTF) (n = 620), matched PTF (mPTF) (one HLA-A and B and one HLA-DR match) (n = 86) or donor-specific blood transfusion (DST) (n = 100) between 1996 and 2006 were collected. Complement-dependent cytoxicity was used to detect anti-HLA antibodies. Sensitization and transplantation outcomes after a PTF were analyzed. Non-immunized female renal transplant recipients who did not receive a PTF were used as the control group.Results. In 165 patients, anti-HLA antibodies (IgG) were detected after the PTF. Both historical and primary sensitizations were found. A DST induced donor-specific anti-HLA antibodies in 25% of the DST recipients. Our policy did not improve transplantation outcome in recipients of a kidney from a deceased donor (n = 368) or in recipients of a living donor [DST (n = 49) and mPTF (n = 66)].Conclusions. A PTF did elucidate historical sensitization but induce primary sensitization as well. No beneficial effect of PTFs on transplantation outcome was found, and PTFs with the intention to detect historical sensitization are therefore not suggested.

KW - acute rejection

KW - graft survival

KW - kidney

KW - pre-transplant blood transfusion

KW - sensitization

KW - DONOR-SPECIFIC TRANSFUSIONS

KW - RENAL-ALLOGRAFT RECIPIENTS

KW - REGULATORY T-CELLS

KW - CROSS-MATCH

KW - ACUTE REJECTION

KW - CYCLOSPORINE ERA

KW - GRAFT-SURVIVAL

KW - FLOW-CYTOMETRY

KW - TERM

KW - ANTIBODIES

U2 - 10.1093/ndt/gfp233

DO - 10.1093/ndt/gfp233

M3 - Article

SN - 0931-0509

VL - 24

SP - 2559

EP - 2566

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 8

ER -

Pre-kidney-transplant blood transfusions do not improve transplantation outcome: a Dutch national study

Abstract

Keywords

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