C. Pizzi

The Cadaver Kidney Transplantation Programme Of Milano Immunological Report

A retrospective investigation was carried out to evaluate the infuence of HLA (A, B) matching, blood transfusions, and preexistence of lymphocytotoxic antibodies on the outcome of the cadaver kidney graft: only non-NIH standard antibodies were considered, since patients with NIH standard antibodies do not undergo transplantation in the programme of Milano. It was found that (1) about one-half the patients with transplants had antibodies in their pretransplant serum. The preexistence of antibodies directed against B lymphocytes had an unfavourable effect on the graft survival; (2) the graft did particularly well in the nonimmunized patients who had been previously transfused; the graft survival was about 80% at 3 years in these patients; and (3) the HLA (A, B) match influenced the graft survival only in patients with antibodies.

Evaluation Of The Blood Transfusion Policy Of The North Italy Transplant Program

A retrospective investigation carried out on the results of the 319 first cadaver kidney transplants performed from 1972 to 1977 in the North Italy Transplant Program (NITP) had indicated that graft survival was significantly better in transfused than in nontransfused patients (64% versus 47% at 2 years, P < 0.05) and was particularly good (80% at 3 years) in those transfused patients who had not produced lymphocytotoxic antibodies even if the HLA match was not particularly good. These data prompted a transfusion policy (starting January 1, 1978): the patients receive 3 units of packed red blood cells at 15-day intervals. A good HLA match is mandatory only for immunized recipients. This policy was expected to improve the results of the transplantation program while reducing the costs of organ sharing. The results of the 165 cadaver kidney transplants performed from January 1978 to June 1980 have confirmed the expectation. They can be summarized as follows: 1. Kidney graft survival has increased significantly (from 50 to 65% at 2 years); in transfused patients it is close to 70% as expected. 2. Kidney graft survival is better in transfused non-immunized patients than in those who have produced lymphocytotoxic antibodies (71% versus 62% at 2 years). 3. A good HLA-A,B match seems important particularly for immunized recipients. No firm conclusion can still be drawn insofar as the influence of the HLA-DR match on graft survival is concerned. 4. A positive B cell crossmatch (carried out at 22 C after platelet absorption) seems to have a detrimental effect on graft survival. 5. Peroperative transfusion, if effective, is not as effective as pretransplant transfusions in improving the graft survival. 6. The incidence of immunized recipients after three deliberate transfusions is acceptable, but because of the unrestricted use of blood transfusions in dialysis units (in addition to those given deliberately) the incidence of immunized and hyperimmunized patients in the waiting list is growing and this is particularly evident in female patients with previous pregnancies. The liberal use of blood transfusions must be halted to prevent an ever higher proportion of patients to become excluded from transplantation.