[Blood transfusions and kidney transplantation: selection or conditioning of recipients?]

Pretransplant blood transfusions have been shown in retrospective studies to prolong the survival of kidney grafts. We have therefore introduced a new prospective transfusion policy. All patients waiting for a kidney transplant received if possible 5 transfusions at monthly intervals, then 1 every 6 months. From 1.1. 1977 to 31.12. 1978 we transplanted 51 transfused patients. In the present study we investigated: 1. the occurrence of lymphocytotoxic antibodies, 2. the time on dialysis until transplantation and 3. the kidney graft survival. 65% of all patients never had antibodies. Only 6 patients produced antibodies with broad spectrum activity. The occurrence of these antibodies did not significantly influence the graft survival. The majority of the patients without antibodies waited 5 months for transplantation. The few hyperimmunized waited far longer, but nevertheless all finally got a transplant. The actuarial graft survival rate at 1 year was 72%. The results of our program with systematic pretransplant transfusions indicate that the advantages of transfusions override the risk of hyperimmunisation.