Leukocyte antigens in renal transplantation. 1. The paradox of blood transfusions in renal transplantation.

TLDR: This work is not able to show evidence of sensitization of recipients of renal allografts by whole-blood transfusions, thus providing the paradox alluded to in the title.

Abstract: PATIENTS in terminal renal failure who are awaiting renal transplantation are generally maintained on frequent bremodialysis. This period of maintenance may last for several months, during which time the patient may receive a number of whole blood transfusions, depending on the type of machine used for dialysis. This ranges from no transfusions to as many as 100 transfusions in the months immediately before transplantation. As it is known that leukocytes carry transplantation antigens (Medawar, 1946; Friedman et alii, 1961; Rapaport et alii, 1964), it might be expected that these frequent transfusions of whole blood (with leukocytes) would lead commonly to sensitization of potential recipients against a subsequent renal allograft. In fact, because of this theoretical risk of sensitization, many transplantation units use only leukocyte-free blood for transfusions. If this risk is real, it should be possible to demonstrate that renal allografts have a stormier early course, as judged by rejection crises, when the recipient has received a large number of transfusions before grafting. As just the opposite is suggested to be the case by two other units (Dossetor et alii, 1967; Michielsen, 1966), we have examined our own experience in this regard. We, too, are not able to show evidence of sensitization of recipients of renal allografts by whole-blood transfusions, thus providing the paradox alluded to in the title. The implications of the results to be described will be discussed at some length.