Fresh versus stored blood in donor specific transfusion

Area of Science:

• Immunology
• Transplantation Science
• Blood Banking

Background:

• Donor specific transfusions (DST) are used to condition patients for organ transplantation.
• Sensitization to human leukocyte antigens (HLA) following fresh DST can complicate transplantation.
• The impact of stored DST on recipient sensitization and transplant outcomes is not well understood.

Purpose of the Study:

• To evaluate the effect of stored donor specific transfusions (DST) on recipient sensitization.
• To compare transplant outcomes between recipients of fresh versus stored DST.
• To investigate changes in leukocyte populations within stored DST.

Main Methods:

• Randomized trial comparing fresh (<48 hours) and stored (1, 3, 5 weeks) DST in haploidentical, MLC-responsive recipients.
• Monitoring for donor-specific antibodies via crossmatches.
• Leukocyte enumeration and FACS analysis of stored blood aliquots.
• Tracking post-transplant outcomes, including graft rejection.

Main Results:

• No recipients (0/12) receiving stored DST developed positive donor crossmatches, compared to 3/6 fresh DST recipients.
• Post-transplant courses were similar for both groups, with no rejections in stored DST recipients.
• Stored blood showed a decrease in HLA-ABC antigen-bearing cells over time, while B cells and monocytes persisted.

Conclusions:

• Stored donor specific transfusions (DST) can prevent sensitization to human leukocyte antigens (HLA) in transplant recipients.
• Storage of DST appears to be a safe and effective conditioning strategy, potentially improving transplant success rates.
• Further research into the mechanisms of immune tolerance induced by stored DST is warranted.