Systematic transfusion in hemodialyzed patients awaiting grafts: kinetics of anti-t and b lymphocyte immunization and its incidence on graft function.

Since June 1977, a systematic blood transfusion (BT) policy (160 ml of leukocyte-poor washed erythrocytes given every 6 months) has been applied to 126 hemodialyzed patients awaiting a first kidney graft. Only patients who had anti-T or B lymphocyte (T or BLY) antibodies (Ab) killing fewer than 10 or 20% of the panel cells, respectively, entered the protocol. Screening of anti-T and BLY was performed 8, 15, and 21 days after each BT. Patients were removed from the protocol if they developed Ab against more than 10 or 20% of the T or BLY panel cells. The cumulative immunization (all Ab types) averaged 90% after four BTs. Anti-BLY (63%) were more frequent than anti-TLY (49%) after for BTs. No anti-HLA-DR specificity could be attributed to the anti-BLY, whereas 20% of the anti-TLY displayed a particular anti-HLA-A,B specificity. Patients that had had BTs or pregnancies before entering the protocol had a higher degree of immunization. The kinetics of the anti-B or TLY pattern differed greatly both at the level of their detection after 8, 15, and 21 days following one BT and in their development after repeated BTs. Forty-three patients received transplants at various stages of the protocol. Recipients grafted without Ab had the best graft outcome (87 versus 66 actuarial percentage at 3 months), even though their HLA (A,B and DR) matching was inferior. There was no significant difference in recipients who had different subgroups of Ab. These data indicate that immunization is very high even after a few BTs when careful controls are performed and they suggest that BTs do not act via active enhancement.