Donor-Specific Transfusions in Living-Related Transplantation

Abstract

Two-hundred thirty-nine transplants have been performed following donor-specific blood transfusions (DSTs) from 1978 through 1984 at the University of California, San Francisco (UCSF). The results of this experience show that DST provides excellent long-term graft survival in 1-haplotype mismatched pairs. Excellent graft survival has also been obtained in a limited 0-haplotype matched experience. These results are comparable to those achieved with concurrent HLA-identical sibling transplants. Azathioprine coverage during DST administration does appear to decrease DST sensitization to the blood donor in unsensitized patients undergoing a first transplant, encouraging early DST and transplantation in this group. The majority of patients formerly excluded from transplantation because of a post-DST positive B-warm crossmatch can now be successfully transplanted with the use of flow cytometry analysis to rule out previously undetectable low levels of anti-class I antigen activity. The DST protocol by itself does not appear to preclude subsequent cadaveric transplantation in patients sensitized to their blood donor by the DST procedure. Preliminary results of cyclosporin treatment in 1-haplotype matched living-related donor-recipient pairs is reported with a 1-year graft survival rate that is similar to that obtained following cadaveric transplantation at this same center. In summary, the long-term immunologic effect of DST has been confirmed, and the indications and considerations for the optimum use of the DST protocol appear to be more clearly defined.