[Blood transfusion before kidney transplantation, is it indicated?]

The beneficial effect of blood transfusions on the prognosis of renal transplantation has been recognized since 1972, and has led transplant centres to adopt a systematic transfusion policy in end-stage renal disease patients requiring a graft. By the end of the eighties, the dramatic improvement in the results of transplantation, the disappearance of transfusions prescribed in haemodialyzed patients after recombinant human erythropoietin became available and finally the evidence of the transfusion risk have raised questions both on transfusion policy, and even on the reality of the transfusion effect itself. The consequence has been great discrepancy in the current policies of different renal transplantation centres: some countries (USA, Great Britain, Scandinavia, Southern Europe) have nearly abandoned transfusion protocols, while others (Benelux, France) remain confident in their transfusion policy. The effect of transfusions on 1-year graft survival has not been detected since 1988 in multicentre international registry reports. However, recent studies have suggested that transfusions could still have a positive effect, especially on specific endpoints, such as the acute rejection incidence observed after transplantation. Moreover, clinical and biological data show that the transfusion effect and its mechanism could depend on the HLA compatibility between the blood donor and the recipient. This justifies current and further clinical and biological investigations on the topic, in order to evaluate the possible current persistent interest of the transfusion policy before transplantation, and to elucidate the biological mechanisms of this unique attempt at immunomanipulation.