ABSTRACT
Thirty-seven patients were submitted to kidney trasnplantation after transfusion at 2-weeck intervals with 4-week stored blood from their potential donors. All patients and donors were typed for HLA-A-B and DR antigens. The patients were also tested for cytotoxic antibodies against donor antigens before each transfusion. The percentage of penel reactive antibodies (PRA) reative antibodies (PRA) was determined against a selected panel of 30 cell donors before and after the transfusions. The patients were immunosuppressed with azathioprine and prednisone. Rejection crises were treated with methylprednisolone. The control group consisted of 23 patients who received grafts from an unrelated donor but who did not receive donor-specific pretransplant blood transfusion. The incidence and reversibility of rejection episodes, allograft loss caused by rejection, and patient and graft survival rates were determined for both groups. Non-parametric methods (chi-square and Fisher tests) were used for statistical analysis, with the level of significance set at P<0.05. The incidence and reversibility of rejection crises during the first 60 post-transplant days did not differ significantly between groups. The actuarial graft and patient survival rates at five years were 56 percent and 77 percent, respectively, for the treated group and 39,8 percent and 57.5 percent for the control group. Graft loss due to rejection was significantly higher in the untreated group (P = 0.0026) which also required more intense immunosuppression (P = 0.0001). We conclude that tranfusions using stored blood have the immunosuppressive effect of fresh blood transfusions without the risk of provoking a widespread formation of antibodies. In addition, this method permits a reduction of the immunosuppressive drugs during the process with-out impairing the adequate funsctioning of the renal graft.
Subject(s)
Adult , Humans , Female , Middle Aged , Azathioprine/therapeutic use , Blood Transfusion/methods , Graft Rejection/blood , Immunosuppression Therapy , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/adverse effects , Prednisone/therapeutic use , Follow-Up Studies , Graft Rejection/drug therapyABSTRACT
The survical of 502 kidney grafts (458 first-grafts and 44 seconda-grafts) performed at Hospital das Clínicas, Faculdade de Medicina, Universidade de Säo Paulo, was analyzed in relation to the degree of HLA compatibility. The actuarial graft survival for first-transplants, at 1 and 5 years, was a follows: a) HLA-identical donor: 90 and 83%; b) one-haplotype identical donor: 68 and 54%; c) unrelated living donor: 61 and 37.5% and d) cadaver donor: 52.5 and 32%. These survival data are similar to those reported by other transplantation groups and confirm the important role of the HLA antigens in the outcome of renal transplantation