Zalpuri Saurabh, Evers Dorothea, Zwaginga Jaap Jan, Schonewille Henk, de Vooght Karen M K, le Cessie Saskia, van der Bom Johanna G
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Transfusion. 2014 Aug;54(8):1981-7. doi: 10.1111/trf.12639. Epub 2014 Apr 1.
Patients receiving red blood cell (RBC) transfusions are at risk of developing alloantibodies against donor RBC antigens. The risk of alloimmunization is dependent on the number of units administered and patient's genetic predisposition, but has also been suggested to be modulated by a patient's clinical profile. Our aim was to examine whether immunosuppressants suppress the development of clinically relevant RBC antibodies.
A two-center case-referent study was performed where case patients and control patients were sampled from all consecutive patients (17,750 patients) who had received their first and subsequent RBC transfusions in a 5-year period in the study centers. Cases were all patients with a first detected RBC alloantibody preceded by negative antibody screens. Control patients were two-to-one matched to the case patients on the number of RBC transfusions. Logistic regression analysis was used to examine the association between immunosuppressant exposure and the subsequent occurrence of RBC alloimmunization.
A total of 156 case patients and 312 control patients in the study received a median of six transfusions (interquartile range, 3-11). Among the total study population, 207 patients received immunosuppressive therapy, with 142 patients receiving only corticosteroids, four receiving only other immunosuppressants, and 61 receiving both. The incidence of alloimmunization among patients using immunosuppressants was lower than among other patients receiving RBCs (adjusted relative rate, 0.55; 95% confidence interval, 0.34-0.91).
Our findings support a considerably lower risk of alloimmunization with the use of immunosuppressive medications.
接受红细胞（RBC）输血的患者有产生针对供体RBC抗原的同种抗体的风险。同种免疫的风险取决于输注的单位数量和患者的遗传易感性，但也有人认为会受到患者临床特征的调节。我们的目的是研究免疫抑制剂是否能抑制临床上相关的RBC抗体的产生。
进行了一项双中心病例对照研究，病例患者和对照患者从研究中心5年内接受首次及后续RBC输血的所有连续患者（17750例患者）中抽取。病例为所有首次检测到RBC同种抗体且之前抗体筛查为阴性的患者。对照患者与病例患者在RBC输血次数上按2:1进行匹配。采用逻辑回归分析来研究免疫抑制剂暴露与随后发生的RBC同种免疫之间的关联。
研究中的156例病例患者和312例对照患者接受输血的中位数为6次（四分位间距，3 - 11次）。在整个研究人群中，207例患者接受了免疫抑制治疗，其中142例患者仅接受皮质类固醇治疗，4例仅接受其他免疫抑制剂治疗，61例同时接受两者治疗。使用免疫抑制剂的患者中同种免疫的发生率低于接受RBC输血的其他患者（调整后的相对率为0.55；95%置信区间，0.34 - 0.91）。
我们的研究结果支持使用免疫抑制药物时同种免疫风险显著降低。
