Vella J P, O'Neill D, Atkins N, Donohoe J F, Walshe J J
Department of Nephrology, National Kidney Centre, Beaumont Hospital, Dublin, Ireland.
Nephrol Dial Transplant. 1998 Aug;13(8):2027-32. doi: 10.1093/ndt/13.8.2027.
Antibodies directed against human leukocyte antigens (HLAs) impact adversely on renal transplantation. Measures aimed at preventing such antibody formation are thus important. The introduction of recombinant human erythropoietin (rHuEpo) has permitted the reduction of blood transfusion in patients with chronic renal failure. The impact of rHuEpo on the incidence of sensitization in patients awaiting transplantation was therefore studied.
A retrospective analysis of the patients awaiting transplantation before (group A) and 4 years after (group B) the introduction of rHuEpo was performed in order to ascertain changing patterns in the use of blood transfusion and causes of sensitization.
The total number of transfusions administered to haemodialysis patients decreased by 34% during the study period. This was accompanied by a significant reduction in the ratio of blood transfusion to haemodialysis treatment episodes (0.095 in group A to 0.06 in group B, P = 0.001). The number of patients sensitized as a consequence of blood transfusion decreased from 63% in group A to 28% in group B (P = 0.0004). The overall incidence of sensitization decreased from 50% in group A to 36.5% in group B (P = 0.008). This decrement was associated with a significant reduction in the mean waiting time for transplantation (42.1 +/- 1.1 vs 15.4 +/- 2.4 months, P < 0.0001). The incidence of sensitization due to previous transplantation increased during the study period from 41% in group A to 77% in group B, (P = 0.0004). There was no change in the number of patients sensitized due to pregnancy.
The introduction of rHuEpo has resulted in a significant decrease in the requirements for blood transfusion among patients awaiting transplantation and is associated with a significant reduction in transfusion-related sensitization and mean waiting time for transplantation.
针对人类白细胞抗原（HLA）的抗体对肾移植产生不利影响。因此，旨在预防此类抗体形成的措施很重要。重组人促红细胞生成素（rHuEpo）的引入使得慢性肾衰竭患者的输血次数得以减少。因此，研究了rHuEpo对等待移植患者致敏发生率的影响。
对引入rHuEpo之前（A组）和之后4年（B组）等待移植的患者进行回顾性分析，以确定输血使用模式的变化以及致敏原因。
在研究期间，血液透析患者的输血总量减少了34%。这伴随着输血与血液透析治疗次数之比的显著降低（A组为0.095，B组为0.06，P = 0.001）。因输血致敏的患者数量从A组的63%降至B组的28%（P = 0.0004）。总体致敏发生率从A组的50%降至B组的36.5%（P = 0.008）。这种下降与移植平均等待时间的显著缩短相关（42.1±1.1对15.4±2.4个月，P < 0.0001）。在研究期间，因先前移植致敏的发生率从A组的41%升至B组的77%（P = 0.0004）。因妊娠致敏的患者数量没有变化。
rHuEpo的引入导致等待移植患者的输血需求显著减少，并与输血相关致敏和移植平均等待时间的显著缩短相关。
