Faculty Collaboration Database

Sensitization from transfusion in patients awaiting primary kidney transplant. Nephrol Dial Transplant 2013 Nov;28(11):2908-18

Date

09/07/2013

Pubmed ID

24009295

Pubmed Central ID

PMC3811060

DOI

10.1093/ndt/gft362

Scopus ID

2-s2.0-84890045873 (requires institutional sign-in at Scopus site)   68 Citations

Abstract

BACKGROUND: Sensitization to human leukocyte antigen (HLA) from red blood cell (RBC) transfusion is poorly quantified and is based on outdated, insensitive methods. The objective was to evaluate the effect of transfusion on the breadth, magnitude and specificity of HLA antibody formation using sensitive and specific methods.

METHODS: Transfusion, demographic and clinical data from the US Renal Data System were obtained for patients on dialysis awaiting primary kidney transplant who had ≥ 2 HLA antibody measurements using the Luminex single-antigen bead assay. One cohort included patients with a transfusion (n = 50) between two antibody measurements matched with up to four nontransfused patients (n = 155) by age, sex, race and vintage (time on dialysis). A second crossover cohort (n = 25) included patients with multiple antibody measurements before and after transfusion. We studied changes in HLA antibody mean fluorescence intensity (MFI) and calculated panel reactive antibody (cPRA).

RESULTS: In the matched cohort, 10 of 50 (20%) transfused versus 6 of 155 (4%) nontransfused patients had a ≥ 10 HLA antibodies increase of >3000 MFI (P = 0.0006); 6 of 50 (12%) transfused patients had a ≥ 30 antibodies increase (P = 0.0007). In the crossover cohort, the number of HLA antibodies increasing >1000 and >3000 MFI was higher in the transfused versus the control period, P = 0.03 and P = 0.008, respectively. Using a ≥ 3000 MFI threshold, cPRA significantly increased in both matched (P = 0.01) and crossover (P = 0.002) transfused patients.

CONCLUSIONS: Among prospective primary kidney transplant recipients, RBC transfusion results in clinically significant increases in HLA antibody strength and breadth, which adversely affect the opportunity for future transplant.

Author List

Yabu JM, Anderson MW, Kim D, Bradbury BD, Lou CD, Petersen J, Rossert J, Chertow GM, Tyan DB

Author

Matthew W. Anderson MD, PhD Assistant Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antibodies
Antibody Formation
Blood Transfusion
Cross-Over Studies
Female
HLA Antigens
Humans
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Prospective Studies
Renal Dialysis
Waiting Lists