Lansbergen Q

Retrospective And Prospective Studies On The Effect Of Blood Transfusions In Renal Transplantation In The Netherlands

The effect of blood transfusion on cadaveric kidney graft survival was studied retrospectively in 103 Dutch recipients. Seventy-four patients who had never been transfused or pregnant before transplantation had a 1-year graft survival of 32%, whereas 30 patients with only one transfusion had a very superior graft survival of 87% after 1 year (X2 = 22.85 P < 0.00001). Nineteen patients who received prospectively 1 unit of leucocyte-poor blood before transplantation had a 79% graft survival after 240 days. This is not statistically different from the results in the retrospective group with one transfusion. Patients who received prospectively 1 or 3 units leucocyte-free blood before transplantation had a 25% graft survival after 240 days. This does not differ from the graft survival in the never-transfused retrospective group (X2 = 0.31, P = 0.57). HLA matching between kidney donor and recipient could not explain the difference between the two prospectively transfused groups. For both groups the average number of HLA mismatches was equal, namely, 1.7. The average number of HLA mismatches between blood transfusion donors and kidney recipients also did not play a role of importance in both prospectively transfused groups. Even repeated mismatches on the blood transfusion donor as on the kidney donor did not give a worse graft outcome. There was no clear-cut correlation between kidney graft survival and the time of transfusion in the retro- as well as in the prospective groups. The fact that the mean hemodialysis period was longer in the leucocyte-poor prospectively transfused group than in the leucocyte-free transfused group could not explain the better graft survival in the first group, as they received only one transfusion. Finally, there was no beneficial effect seen of peroperative blood transfusions on kidney graft prognosis.

Effect of HLA-A and HLA-B Matching on Survival of Grafts and Recipients after Renal Transplantation

Data on the effect of HLA-A and HLA-B matching between unrelated donors and recipients focus mainly on graft survival. After linking the follow-up data of the European Dialysis and Transplant Association and those of the Eurotransplant Foundation, the effect of HLA-A and HLA-B matching on recipient survival could be studied. Recipients of well-matched kidneys--i.e., without mismatches for the HLA-A and B antigens--had 51 per cent graft survival at five years, whereas recipients of grafts mismatched for four antigens had 32 per cent graft survival at five years. The overall P value between the five different mismatch classes was 0.0005. Patient survival at five years was 72 per cent in recipients of a kidney without HLA-A and B mismatches and 54 per cent in recipients of a completely mismatched donor kidney (overall, P = 0.001). These results suggest that matching for the HLA antigens has a beneficial long-term effect not only on renal-allograft survival but also on patient survival.

The importance of H-Y incompatibility in human organ transplantation.

SUMMARY As an extension of our first observation in which the peripheral blood lymphocytes of an aplastic amaemia patient with a transplant were able to show HLA-restricted H-Y killing in a cell-mediated lympholysis assay, we report here a second case showing exactly the same phenomenon. A multitransfused woman suffering from aplastic anaemia was shown to have in vitro killing after priming her lymphocytes with her HLA-identical brother. This killing was directed to all male target cells carrying the HLA-A2 antigen. Marginally, killing was also directed to some HLA-A2 female target cells, but this was at a considerably lower level than that directed to male cells. The level of HLA-restricted H-Y killing declined with time. However, it was possible to reactivate the H-Y specific killing by in vitro stimulation with lymphocytes from an HLA-A, -B, and -C-identical, but HLA-D-different male donor. That these findings could be relevant for renal transplantation was supported by renal allograft survival data obtained at 2 years after transplantation. Male allografts from HLA-A2-positive donors in A2-positive females survived for a significantly shorter time than non-A2 male kidneys in non-A2 female recipients. This was only apparent in recipients who produced antileukocyte antibodies.

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.