The transfusion effect.

1. Many transplant centers have apparently abandoned their deliberate transfusion protocols believing that the beneficial effect of transfusions no longer outweighs the risks. 2. Pretransplant blood transfusions have consistently improved graft survival among recipients of first cadaver donor transplants. One-year graft survival rates were 5-8% higher for transfused patients transplanted each year between 1982 and 1987. Transplants performed in 1988 and 1989 showed a 3% improvement with transfusions. 3. Whereas large numbers of transfusions resulted in higher 1-year graft survival rates in the precyclosporine era, 2 or 3 transfusions provided the maximum effect in more recent transplants. 4. A disturbing decrease in the long-term survival of transplants to nontransfused patients and patients given 1-4 transfusions has been noted. Nontransfused recipients transplanted since 1985 had a higher loss rate after the first year than those transplanted prior to 1982. If this trend can be verified as more follow-up becomes available, it suggests that the transfusion effect has become a factor in long-term survival rather than one that affects only the immediate posttransplant period. 5. Transfusions decreased the risk and apparent severity of early rejection episodes. Twenty-six percent of transfused patients had early rejection and 1-year graft survival was 67%. Among nontransfused patients, rejections occurred in 42% and survival was 56%. Patients with no early graft dysfunction had 89% 1-year graft survival when transfused and 83% when not transfused. 6. Transfusions improved 1-year graft survival by 7% for Asian recipients, 6% for Blacks, and 4% for Whites. The improvement within each racial group was significant. 7. Kidneys that were mismatched for HLA-DR antigens and kidneys from donors younger than age 16 had significantly poorer survival when transplanted to nontransfused patients. Transfusions mitigated the effects of mismatching and donor age on 1-year graft survival.(ABSTRACT TRUNCATED AT 250 WORDS)