Reduction of accelerated failures by transfusion

P. I. Terasaki, S. Perdue, G. Ayoub, Y. Iwaki, M. S. Park, M. R. Mickey

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Transfusions have their greatest effect in the first month following transplantation by reducing the accelerated rejection occurring in the first month. They have almost no effect after the third month posttransplantation. The difference in failure rates on first, second, or third transplants occurs mainly within the first month posttransplantation. Whereas 10% of first grafts failed to function, 22% of second grafts and 31% of third grafts into patients with cytotoxic antibodies failed to function. Thus there is a strong correlation between kidneys that never function and the presence of preformed cytotoxic antibodies in second and third transplants. There is some increase in nonfunctioning kidneys from 5% to 13% in kidneys stored for 6 hours to kidneys stored for more than 24 hours. There was very little difference between machine and cold storage. In patients who were recorded as never having received transfusions, 29% of those with polycystic kidney disease (and, therefore, unlikely to have received unreported transfusions) underwent accelerated rejection within the first month. With transfusions this accelerated rejection rate was reduced dramatically to approximately 10%. Pregnancy did not produce an increase in accelerated rejection rates nor an increase in nonfunctioning kidneys. Following more than 11 transfusions, 40% developed antibodies but only 15% developed high levels of antibodies. The remainder of sensitized patients either had peak antibody levels with subsequent decrease or fluctuating levels. The prospective trials have resulted in 83% 1-year transplant survival in patients with more than 10 transfusions. This rate was higher than the 65% 1-year graft survival with more than 10 transfusions seen in the total retrospective study. Transfusions had an additive effect to HLA-A,B matching and it produced its greatest effect in patients who were 2 HLA-DR antigen matched (88% 1-year survival rate). HLA-A2 was not found to be a significant antigen either as a mismatch or as the antigen which is most frequently mismatched in random blood transfusions. Rh appeared to influence the outcome only in cases where the recipient and donor were Rh negative. With more than five transfusions, a 1-year graft survival rate of 83% was obtained in Rh negative donors to Rh negative recipients.

Original languageEnglish (US)
Pages (from-to)251-259
Number of pages9
JournalTransplantation Proceedings
Volume14
Issue number2
StatePublished - 1982
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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