[Immunologic selection of renal transplant donors and recipients: blood transfusions]

Blood transfusions clearly improve the prognosis of cadaver kidney transplantation. The percentage of graft survival at one year is increased, about + 25%. Preoperative transfusions are effective, whereas peroperative transfusions are ineffective. The following technique seems to be good. Each patient should first receive 5 blood transfusions over a short time lapse, and then one unit of blood from time to time, two times per year for example. The blood must be less than three days old and must contain leucocytes. Transfusions induce, in a few hemodialysed patients, an anti-HLA immunisation. It is thus necessary to choose a donor with a negative cross-match. Transfusions induce in many patients a better tolerance for kidney transplant. This tolerance is perhaps immunologically specific. Blood transfusions are also useful for the selection of related donors HLA semi identical with recipients. The recipient is transfused several times with donor's blood. Transplantation is only performed when the cross-match remains negative and then leads to a high percentage of success.