G.F.J. Hendriks

Effect of One-HLA-DR-Antigen–Matched and Completely HLA-DR–Mismatched Blood Transfusions on Survival of Heart and Kidney Allografts

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.

EXCELLENT OUTCOME AFTER TRANSPLANTATION OF RENAL ALLOGRAFTS FROM HLA-DRw6-POSITIVE DONORS EVEN IN HLA-DR MISMATCHES

The effect of the presence or absence in the donor of HLA-DRw6 on the survival of renal allografts was studied in 759 HLA-DRw6-negative recipients. The definition of HLA-DRw6 was consistent throughout the study period. 578 patients received an allograft with one HLA-DR mismatch and 181 an allograft with two HLA-DR mismatches. Allograft survival at 1 year was significantly better when the donors were HLA-DRw6-positive than when they were HLA-DRw6-negative, for both one-DR-mismatched (86% vs 65%) and two-DR-mismatched (85% vs 59%) allografts.

INFLUENCE OF POSSIBLE HL-A HAPLOIDENTITY ON RENAL-GRAFT SURVIVAL IN EUROTRANSPLANT

Abstract Graft prognosis in 435 leucocytotoxin-free recipients of a kidney graft was not significantly improved by matching for the serologically defined antigens. It could, however, be shown that 108 donor-recipient combinations which shared either the HL-A 1 and 8, or the HL-A 2-12, or the HL-A 3-7 antigens had a significantly better prognosis (70% after 18 months) than 40 combinations mismatched for these antigens (41% after 18 months, p

Prevention of CMV Infection by Screening for CMV Antibodies in Renal Allograft Recipients and Their Blood and Kidney Donors

The influence of the cytomegalovirus (CMV) serostatus of blood and kidney donors on patient and graft survival was studied prospectively in 73 cadaveric renal graft recipients. Six out of 12 (50%) CMV seronegative recipients receiving a kidney from a CMV seropositive donor developed CMV disease, in contrast to none of 7 CMV seronegative donor/recipient combinations. Transmission of CMV with blood products to seronegative recipients was not observed in this study. A poor graft survival of 41% 3 years after transplantation was found in CMV seronegative recipients with CMV seropositive allograft donors, compared with an actuarial 3 year graft survival of 72% in the 7 CMV seronegative donor/recipient combinations. Six patients with graft failure had a CMV infection. This study, in accordance with other studies, suggests that selection of CMV seronegative renal allograft donors for CMV seronegative recipients will improve graft survival.

High and low responsiveness in renal transplantation and its impact on HLA matching

The question whether or not HLA matching can modify the amount of immunosuppressive drugs needed for good graft survival can, of course, be answered in the affirmative. It is a well established fact that grafts exchanged between HLA-identical sibling donor-recipient combinations require less immunosuppression and survive better than grafts exchanged between mismatched living related combinations, and, of course, than grafts obtained from cadaveric donors.