Presentation Authors: Mitsuru Saito*, Shigeru Satoh, Takuro Saito, Ryohei Yamamoto, Taketoshi Nara, Syuji Chiba, Sohei Kanda, Kazuyuki Numakura, Shintaro Narita, Takamitsu Inoue, Tomonori Habuchi, Akita, Japan
Introduction: Blood transfusion, pregnancy, and transplantation could be risk factors for sensitization. Kidney transplant recipients are potently immunosuppressed in the early phase after kidney transplantation. However, little is known about the impact of posttransplant blood transfusion on the sensitization of anti-HLA antibodies and the formation of de novo donor-specific antibodies (dnDSAs). This study aimed to determine the 1-year incidence of dnDSAs and antibody-mediated rejection (ABMR) in kidney transplant recipients who had or had not received blood transfusion within 1 year after kidney transplantation.
Methods: From July 2004 to September 2013, 163 kidney transplant recipients were enrolled in this study. The patients were divided into two groups: transfusion and nontransfusion group. For 1 year after kidney transplantation, all patients were evaluated for the formation of dnDSAs using Luminex assays. Induction immunosuppressive therapy followed a modern immunosuppressive protocol comprising tacrolimus, mycophenolate mofetil, steroid, and basiliximab. Patients at an immunologically high risk due to ABO blood-type incompatibility or the presence of donor-specific anti-HLA antibodies were administered a single low dose of rituximab and underwent three or four sessions of apheresis before kidney transplantation. In this study, plasmapheresis using fresh frozen plasma (FFP) and drip infusion of FFP and platelets were evaluated as blood transfusion methods.
Results: Of the 163 patients, 67.9% (n=112) received blood transfusion within 1 year after kidney transplantation, most within the first week itself. The transfusion group comprised significantly more females than the nontransfusion group (p = 0.03). The hemoglobin level of patients in the transfusion group immediately before kidney transplantation was significantly lower compared with that of patients in the nontransfusion group (10.1 Â± 1.4 vs. 11.2 Â± 1.2, respectively; p < 0.001). In addition, ABMR occurred significantly more frequently in the transfusion group (p = 0.015) compared with the nontransfusion group. If, however, patients at an immunologically high risk (n = 45) were excluded, we found no difference in the incidence of dnDSA formation and ABMR between the groups.
Conclusions: Early blood transfusion after kidney transplantation is not an independent risk factor for dnDSA formation and ABMR because of an under-immunosuppressed condition.