Role of blood transfusion in transplantation: a review

The ultimate goal of transplantation immunology is induction of donor-specific tolerance without the need for chronic immunosuppression. A number of strategies have been used to induce tolerance, including donor-specific blood transfusion (DST). A large number of experimental and clinical studies have evaluated the ability of DST to induce tolerance in solid organ transplantation. In contrast, a limited number of experimental studies have been reported evaluating the effect of DST in induction of tolerance in composite tissue allograft transplants. DST applications include cadaveric and living-related graft recipients in humans, leading to achievement of microchimerism. Although the mechanism of action is still uncertain, microchimerism with the concomitant persistence of soluble donor HLA antigen is considered to be the most significant contributing factor. In this article, the experimental and clinical applications, as well as the immunomodulatory mechanism of DST, are reviewed.