A randomized study comparing leukocyte‐depleted versus packed red cell transfusions in prospective cadaver renal allograft recipients

Fp, Sanfilippo; Bollinger, R. Randal; MacQueen, J. M.; Brooks, BJ; Koepke, J.A.

doi:10.1046/j.1537-2995.1985.25285169200.x

Cited by 25 publications

(20 citation statements)

References 22 publications

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“…Previous studies have also reported that leukoreduction of blood products is ineffective in decreasing sensitization in previously transplanted patients and in potential kidney transplant candidates (48)(49)(50). A possible reason for this finding is that the number of HLA molecules contributed by the red blood cells is similar to that of the leukocytes (51).…”

Section: Effect Of Leukocyte Depletion On Risk Of Hla Sensitization Amentioning

confidence: 97%

Effect of Red Cell Transfusions on Future Kidney Transplantation

Obrador

Macdougall

2013

Clinical Journal of the American Society of Nephrology

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SummaryRed cell transfusions, erythropoiesis-stimulating agents (ESAs), and intravenous iron therapy all have a place in the treatment of anemia associated with CKD. Their relative merits and uses are subject to many clinical and nonclinical factors. New concerns associated with the use of ESA therapy make it likely that the use of blood transfusions will increase, refueling previous debates about their associated risks. Data on whether red cell transfusions increase sensitization to HLA antigens, rendering subsequent transplantation more problematic, are mainly derived from older literature. Older data suggested that women were more at risk of HLA sensitization than men, particularly those with previous multiple pregnancies, although recent U.S. Renal Data System data have challenged this. HLA sensitization prolongs the waiting time for transplantation and reduces graft survival. Leukocyte depletion of red cells does not appear to reduce the risk of HLA sensitization. This review summarizes much of the data on these issues, as well as highlighting the need for further research on the potential risks for blood transfusion in patients with CKD.

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Section: Effect Of Leukocyte Depletion On Risk Of Hla Sensitization Amentioning

confidence: 97%

Effect of Red Cell Transfusions on Future Kidney Transplantation

Obrador

Macdougall

2013

Clinical Journal of the American Society of Nephrology

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“…The few studies that have examined this practice either have been uncontrolled or have screened for allosensitization using technically inferior anti-HLA antibody screening techniques (10,11). Several recent studies have highlighted the superior sensitivity of flow cytometric anti-HLA antibody screening (FlowPRA) (12)(13)(14).…”

mentioning

confidence: 99%

Leukocyte Reduction of Red Blood Cell Transfusions Does not Decrease Allosensitization Rates in Potential Kidney Transplant Candidates

Karpinski¹,

Pochinco²,

Dembinski³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. A significant proportion of potential kidney transplant candidates continue to periodically require blood transfusions that carry a risk of allosensitization. Leukocyte reduction (leukoreduction) of blood products has been proved to reduce transfusion-associated allosensitization in patients with hematologic malignancies; however, the effect in potential kidney transplant candidates is unknown. A total of 112 kidney transplant candidates who received red blood cell transfusions while on the transplant waiting list were identified retrospectively. Sixty received a transfusion before leukoreduction (non-LR), and 52 received a transfusion after the local implementation of universal leukoreduction of blood products (LR). There was no difference in transfusion-associated allosensitization rates in patients who received a transfusion during the two eras (non-LR 27% [16 of 60] versus LR 33% [17/52]; NS). Likewise, no difference was observed in subgroups identified as being at high risk of allosensitization (previous pregnancy, transplant, or five or more previous transfusions) or at low risk (no previous allogeneic exposures) (high risk: non-LR 52% versus LR 55%; low risk: non-LR 10% versus LR 8%). Multivariate analysis revealed previous pregnancy to be the only significant risk factor associated with transfusion-associated allosensitization (relative risk, 8.2; 95% confidence interval, 2.4 to 24.0; P ϭ 0.0001). Leukoreduction, in particular, was not associated with any protective effect. In summary, leukoreduction of red blood cell transfusions does not confer any protection against transfusion-associated allosensitization for potential kidney transplant candidates. Physicians who care for patients with ESRD must continue to practice careful transfusion avoidance while alternative strategies to minimize transfusion associated allosensitization are sought.Despite the fact that recombinant erythropoietins have substantially decreased the need for transfusions in patients with ESRD, United Network for Organ Sharing (UNOS) data indicate that approximately 30% of wait-listed transplant candidates continue to receive red blood cell (RBC) transfusions at some point before transplantation (1, 2). In the past, some transplant programs administered deliberate pretransplant transfusions aimed at optimizing graft outcomes (i.e., the beneficial transfusion effect); however, more recent data indicate that this beneficial effect is no longer apparent, perhaps as a result of improving graft outcomes overall (2-5). Concerns of transfusion-associated allosensitization persist for potential transplant candidates, and it is likely that the majority of current transfusions are administered for other clinical indications.

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“…Results of our study are in accordance with the results mentioned above, since we demonstrated no statistically significant difference in the average levels of sensitization for both the group of patients who received filtrated blood products and the group of patients who received standard blood products (t= -0.797, border value for p<0.05, t= 1.97). Our results could be explained by the fact that among the group of patients who received leukodepleted blood products, females, who have relatively higher chance to be alloimmunized than males due to previous pregnancies, represent 25.94% of group, which is higher than 17.06% of women in the group of patients who received non leukodepleted blood products. Another explanation for the fact that our study showed no statistically significant difference in the average levels of sensitization for the group of patients who received filtrated blood products vs. the group of patients who received standard blood products was the fact that both leukocytes and red cells carry a significant HLA antigen load, and residual leukocytes and/or red cell HLA may explain why leukocyte-reduced units are unable to prevent sensitization to any significant degree [28,29].…”

Section: Discussionmentioning

confidence: 65%

“…In the 1980s, SanFilippo et al [25] conducted a randomized study transfusing renal transplant candidates with either standard or leukoreduced red blood cell units and found no difference in allosensitization rate. According to study of Karpinski et al, [26] no significant difference in the rate of transfusion-associated allosensitization in renal transplant candidates who received either standard or leukoreduced red blood cell transfusions were found (27% versus 33%, respectively).…”

Section: Discussionmentioning

confidence: 99%