Peri-Transplant Blood Transfusion Is Associated With Significant Formation of HLA Antibodies Despite Immunosuppression.

Abstract

Blood transfusion is a recognised source of allo-sensitization in transplantation. Despite pre-treatment with immunosuppressive therapy transfusion in the perioperative period may potentially increase the risk of sensitization. We studied the prevalence of transfusion during the transplantation period in our centre and analysed the impact on HLA antibody status. We retrospectively analysed all adult kidney recipients transfused with leuko-depleted red blood cells and platelets during the first 48 hours of transplantation surgery from January 2010-April 2013. HLA antibody screening was performed by single antigen Luminex® bead assay (GenProbe). HLA antibodies and donor specific antibodies (DSA) pre- and post-transplantation (between days 14-31) were analysed. All patients (n=187) received corticosteroid, tacrolimus and mycophenolic acid based immunosuppression. We also examined the occurrence of Delayed Graft Function (DGF) and incidence of acute rejection in the first 2 months post transplant compared with an un-transfused control group. Among 187 patients included in the study, 67 patients (36%) received blood transfusion (median 2 units) and 120 patients (64%) were not transfused. 18 patients (29%) among the transfused group developed HLA antibodies compared to 12 (10.4%) in the non-transfused group. The risk factors for sensitization with transfusion were female recipients, second graft recipients, primary polycystic kidney disease and non-Caucasian populations- all were more likely to develop HLA Antibodies. Transfused kidney transplant recipients developed clinically significant HLA antibodies (MFI>300) [ Odds ratio 3.37] in 26% of cases. A higher rate of DGF was observed in the transfused group compared to the un-transfused group. Conclusion: Despite immunosuppressive drug therapy with tacrolimus, mycophenolic acid, cortico-steroid and IL2Receptor blockade, blood transfusion in the peri-operative period is associated with significant development of HLA antibodies. DISCLOSURES:Coates, P.: Speaker's Bureau, Alexion, Other, Novartis, Advisory Board.