Lagaaij E L, Hennemann I P, Ruigrok M, de Haan M W, Persijn G G, Termijtelen A, Hendricks G F, Weimar W, Claas F H, van Rood J J
Department of Immunohaematology, University Hospital Leiden, the Netherlands.
N Engl J Med. 1989 Sep 14;321(11):701-5. doi: 10.1056/NEJM198909143211101.
Blood transfusions can influence the survival of organ allografts favorably, in spite of the danger of sensitization. We investigated the influence of HLA compatibility between blood donors and transfusion recipients on the production of HLA antibodies and on graft survival. Among recipients of transfusions who shared one HLA-DR antigen with their respective donors, antibodies developed in 6 of 28 who had received one transfusion, in 2 of 16 who had received three transfusions, and in 4 of 24 who had undergone renal transplantation. Among recipients who were mismatched with their donors for both HLA-DR antigens, the rate of sensitization was significantly higher in all three of these groups (18 of 30, P = 0.02; 12 of 16, P = 0.0007; and 12 of 22, P = 0.001). The survival of kidney allografts among graft recipients who were given transfusions and shared one HLA-DR antigen with their blood donors (81 percent at five years) was significantly higher than among recipients who were given transfusions and were mismatched for both HLA-DR antigens (57 percent; P = 0.02) or among recipients who were not given transfusions (45 percent; P = 0.001). There was no difference in graft survival between patients who received transfusions mismatched for two HLA-DR antigens and those who were not given transfusions. We conclude that allograft survival can be improved by pretransplantation blood transfusion when the transfusion recipients share at least one HLA-DR antigen with their donors. In view of the increased rate of sensitization and the lack of improvement in graft survival, the transfusion of blood mismatched for two HLA-DR antigens appears to be contraindicated in candidates for transplantation.
尽管存在致敏风险，但输血仍可对器官移植的存活产生有利影响。我们研究了献血者与输血受者之间的HLA相容性对HLA抗体产生及移植存活的影响。在与各自献血者共享一种HLA - DR抗原的输血受者中，接受一次输血的28人中有6人产生了抗体，接受三次输血的16人中有2人产生了抗体，接受肾移植的24人中有4人产生了抗体。在与献血者的两种HLA - DR抗原均不匹配的受者中，这三组的致敏率均显著更高（30人中有18人，P = 0.02；16人中有12人，P = 0.0007；22人中有12人，P = 0.001）。接受输血且与献血者共享一种HLA - DR抗原的移植受者中肾移植的五年存活率（81%）显著高于接受输血且两种HLA - DR抗原均不匹配的受者（57%；P = 0.02）或未接受输血的受者（45%；P = 0.001）。接受两种HLA - DR抗原不匹配输血的患者与未接受输血的患者之间的移植存活率无差异。我们得出结论，当输血受者与其献血者至少共享一种HLA - DR抗原时，移植前输血可提高移植存活率。鉴于致敏率增加且移植存活率未得到改善，对于移植候选者，输注与两种HLA - DR抗原不匹配的血液似乎是禁忌的。
