Transplantation and the blood bank

Abstract

Blood transfusion could be considered as the earliest form of successful transplantation, although the graft only survives for a short time. In solid organ and bone marrow transplantation supportive care with blood products is essential to a successful outcome. An additional beneficial effect in renal transplantation is pre-transplant blood transfusion which improves graft survival, although the mechanism for this effect is not clear. Undesirable effects of transfusion include; (1) sensitization to HLA and non-HLA antigens which can result in rejection of the graft and/or the development of platelet refractoriness, (2) transmission of infectious agents, particularly cytomegalovirus (CMV) which can interfere with graft function and cause ill effects in the recipient, (3) graft-versus-host disease, especially in bone marrow transplantation (BMT) and, (4) haemolysis in ABO incompatible donor-recipient pairs in BMT. Newer developments to facilitate transplantation and prevent undesirable side effects include; (1) methods to concentrate marrow stem cells prior to cryopreservation or purging, (2) prophylaxis against CMV infections using hyperimmune globulin and CMV negative blood products, (3) use of filtration of blood products to prevent sensitization and transmission of CMV, (4) donor specific transfusions prior to renal transplantation, (6) use of intraoperative blood scavenging in liver transplantation and, (7) ultraviolet and gamma irradiation of blood products.