Red cell antigens and renal transplantation

Area of Science:

• Nephrology
• Immunology
• Transplantation Immunology

Background:

• Living-donor renal transplantation is a crucial treatment for end-stage renal disease.
• Donor-specific transfusions (DST) are used to improve transplant outcomes but can be limited by red cell antigen mismatches.
• The role of cyclosporine in conjunction with DST in the context of red cell mismatches requires further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of donor-specific transfusions (DST) in living-donor renal transplantation despite red cell antigen disparities.
• To assess the influence of cyclosporine on patients undergoing DST with red cell antigen mismatches.
• To determine if red cell antigen mismatching, including ABO and Rh(D), contraindicates DST.

Main Methods:

• A randomized trial involving 80 patients undergoing living-donor renal transplantation.
• Patients received donor-specific transfusions (DST) with or without cyclosporine.
• Red cell antigen mismatches (ABO, Rh(D), atypical antibodies) were not contraindications for DST.

Main Results:

• Donor-specific transfusions (DST) were generally well-tolerated despite ABO and Rh(D) mismatches, and the presence of atypical red cell antibodies (except anti-D).
• DST did not initiate Rh anti-D production but elevated pre-existing anti-D levels.
• One patient receiving ABO-mismatched blood and cyclosporine developed autoimmune hemolytic anemia; a similar patient without cyclosporine did not.

Conclusions:

• Minor red cell antigen disparities, excluding pre-existing anti-D antibodies, should not prevent pretransplant conditioning with donor-specific transfusions (DST).
• The use of cyclosporine during DST may influence the development of auto-antibodies in ABO-mismatched recipients, warranting further study.
• Donor-specific transfusions remain a viable strategy to enhance renal transplant outcomes even with certain red cell incompatibilities.