Aalten Jeroen, Bemelman Frederike J, van den Berg-Loonen Ella M, Claas Frans H, Christiaans Maarten H, de Fijter Johan W, Hepkema Bouke G, Hené Ronald J, van der Heide Jaap J Homan, van Hooff Johannes P, Lardy Neubury M, Lems Simon P, Otten Henderikus G, Weimar Willem, Allebes Wil A, Hoitsma Andries J
Department of Nephrology, University Medical Center Radboud, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
Nephrol Dial Transplant. 2009 Aug;24(8):2559-66. doi: 10.1093/ndt/gfp233. Epub 2009 May 27.
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.
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.
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)].
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.
女性肾移植候选者容易因既往妊娠而致敏，未被检测到的既往致敏可能会降低移植效果。我们研究的假设是，移植前输血（PTF）可以阐明既往致敏情况，避免相关抗原可以改善移植效果。
收集了1996年至2006年间所有接受随机PTF（rPTF）（n = 620）、匹配PTF（mPTF）（一个HLA - A和B以及一个HLA - DR匹配）（n = 86）或供者特异性输血（DST）（n = 100）的未免疫女性肾移植候选者的数据。采用补体依赖细胞毒性检测抗HLA抗体。分析PTF后的致敏情况和移植效果。未接受PTF的未免疫女性肾移植受者作为对照组。
165例患者在PTF后检测到抗HLA抗体（IgG）。发现了既往致敏和初次致敏情况。25%的DST受者中，DST诱导产生了供者特异性抗HLA抗体。我们的策略在接受 deceased donor肾移植的受者（n = 368）或活体供肾受者[DST（n = 49）和mPTF（n = 66）]中未改善移植效果。
PTF确实阐明了既往致敏情况，但也诱导了初次致敏。未发现PTF对移植效果有有益影响，因此不建议为检测既往致敏而进行PTF。
