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Donor-specific transfusion: a report of the Japanese Renal Transplant Registry
1Department of Urology, Osaka University Hospital, Japan.
Insights
Donor-specific transfusions (DST) significantly improve renal transplant survival, especially with cyclosporine (CsA) immunosuppression. Unspecified transfusions also enhance outcomes, highlighting the benefits of blood transfusions in transplantation.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Donor-specific transfusions (DST) are a known method to improve transplant outcomes.
- The role of DST in conjunction with different immunosuppressive regimens requires further elucidation.
- Cyclosporine (CsA) and conventional immunosuppression represent distinct approaches to managing transplant recipients.
Purpose of the Study:
- To investigate the impact of donor-specific transfusions (DST) on renal graft survival in HLA one haplotype-mismatched living-related transplant recipients.
- To compare the efficacy of DST under cyclosporine (CsA) versus conventional immunosuppression.
- To evaluate the effects of unspecified blood transfusions (UTF) in combination with DST.
Main Methods:
- Analysis of 1,292 transplant patients from the Japanese Renal Transplant Registry.
- Stratification of patients based on immunosuppressive therapy (CsA vs. conventional) and transfusion status (DST, DST + UTF, UTF, no transfusion).
- Comparison of 4-year renal graft survival rates across different transfusion and immunosuppression groups.
Main Results:
- In CsA groups, 4-year graft survival rates were: DST (93.5%), DST + UTF (91.6%), UTF (76.2%), and no transfusion (62.7%).
- In conventional groups, 4-year graft survival rates were: DST (73.3%), DST + UTF (87.2%), UTF (73.2%), and no transfusion (69.0%).
- The beneficial effect of DST was more pronounced with CsA than conventional immunosuppression, though DST with UTF showed a superior effect in conventional groups.
Conclusions:
- Donor-specific transfusions (DST) significantly enhance renal graft survival, particularly when combined with cyclosporine (CsA) immunosuppression.
- Unspecified transfusions (UTF) also contribute positively to graft survival, especially when administered alongside DST.
- The combination of DST and CsA therapy appears to yield excellent long-term graft survival rates in HLA-mismatched living-related renal transplants.
Abstract:
1. The effect of donor-specific blood transfusions (DST) on renal graft survival of HLA one haplotype-mismatched living-related transplant patients was studied, and 1,292 transplant patients reported in the Japanese Renal Transplant Registry were analyzed. In the CsA groups, the graft survival rate at 4 years of the DST, DST plus unspecified blood transfusion (UTF), UTF, and no blood transfusion (TF = 0) groups, were 93.5%, 91.6%, 76.2%, and 62.7%, respectively, whereas, in the conventional groups, the graft survival rate at 4 years of the DST, DST plus UTF, UTF, and TF = 0 groups were 73.3%, 87.2%, 73.2%, and 69.0%, respectively. 2. The superior DST effect was prominent in the transplants on CsA, but not in those on conventional immunosuppression. The DST patients receiving UTF, however, showed a superior DST effect. 3. DST patients treated with conventional immunosuppression and the CsA patients receiving UTF showed an equal graft survival rate. 4. Since the CsA therapy was able to achieve a higher graft survival rate in a high MLR combination (S.I. greater than 10), it is likely that the DST patients treated with CsA showed an excellent graft survival rate. 5. The transplant patients without blood transfusion in the CsA and conventional groups achieved a moderate graft survival rate.