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Effect of donor-specific transfusions on renal transplantation in children
Insights
Donor-specific transfusions can improve kidney transplant success in children. This method increases related-donor transplants, with high graft survival rates and minimal complications, making it a successful strategy.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Many potential family kidney donors for children exhibit high mixed lymphocyte culture reactivity, leading to exclusion.
- This high reactivity poses a significant barrier to successful living-related kidney transplantation in pediatric recipients.
Purpose of the Study:
- To evaluate the efficacy and safety of donor-specific transfusions (DST) in pediatric kidney transplant recipients with pre-sensitized or highly reactive mixed lymphocyte cultures.
- To assess the impact of DST on sensitization rates and subsequent transplant outcomes.
Main Methods:
- Fifty pediatric patients, many with highly reactive mixed lymphocyte cultures, received three donor-specific blood transfusions prior to renal transplantation.
- Patients were monitored for the development of lymphocytotoxic antibodies and assessed for sensitization (positive T-cell or B-cell crossmatch).
- Outcomes including graft survival, patient survival, and complications were analyzed.
Main Results:
- Twenty percent (10/50) of children developed sensitization with a positive crossmatch after DST.
- Sensitization rates were lower in children receiving azathioprine during DST (11%) compared to those not treated (26%), though not statistically significant.
- Thirty-seven children underwent transplantation post-DST, with no deaths and only two cases of kidney failure. Actuarial kidney survival was 93% at 6 years.
Conclusions:
- Donor-specific transfusions are a successful strategy to increase the number of related-donor kidney transplants in pediatric recipients, even those with pre-existing high mixed lymphocyte culture reactivity.
- DST significantly improves graft survival rates and is associated with a low incidence of complications, demonstrating its clinical utility.
Abstract:
Most family members who are evaluated as kidney donors for children have high reactivity in a mixed lymphocyte culture test and are thus excluded from donation. Fifty children, most of whom had highly reactive mixed lymphocyte cultures with their donors, were challenged with three blood transfusions from their donors before transplantation and were tested for the development of lymphocytotoxic antibodies. Ten children (20%) became sensitized and had a positive T-cell or B-cell crossmatch. Sensitization occurred less frequently in children treated with azathioprine during donor-specific transfusions (11%) than in those not treated (26%), but the difference was not significant. Thirty-seven children received renal transplants from their blood donors after the donor-specific transfusions. There were no deaths, and only two patients had kidney failure. Actuarial kidney survival was 93% after 6 years. The use of donor-specific transfusion has increased the number of related-donor transplants performed and the results have been highly successful.