REASSESSMENT OF DONOR SPECIFIC BLOOD TRANSFUSION PRIOR TO LIVING DONOR KIDNEY TRANSPLANTATION - A TEN YEAR EXPERIENCE.
S Hsia, DD Nghiem, BJ Carpenter and RJ Marcus, Departments of Laboratory Medicine, Surgery and Internal Medicine, Allegheny General Hospital, Pittsburgh, PA.
We report here our ten years experience on the donor specific blood transfusion (DST) protocol for living donor kidney transplantation(TX). This protocol included administering to the patient (PT) 150 ml donor blood 3 times at two-week intervals and azathioprine (2mg/kg) daily one week prior to the first transfusion(TF), continued until surgery. Each PT was monitored for serum antibodies to donor lymphocytes, T and B cells by crossmatch (XM) before and one week after each TF. Of the 31 PTs who received DST, one developed positive T and B cell XM after the second TF. Of the 30 PTs who completed the protocol, 6 had a transient and 1 a persistent positive B cell XM. Of the 7 PTs with a positive B cell XM, 6 were transplanted with currently functional grafts and one with transient positive B cell XM was lost to follow-up. Of the 23 PTs with a negative B cell XM, 3 lost their grafts and 1 was lost to follow-up after TX. PTs who received primary living donor kidneys were then compared for a DST effect on the graft survival(GS), including 23 with DST and 31 without. PTs with DST had a mean HLA -A, B & DR mismatch score (from 0 to 6) significantly higher than those without DST (P=0.0003), 3.3 + 1.4 and 1.6 + 1.8 respectively. Cumulative GS at 1, 5 & 10 years were 96%, 88% and 88% respectively and those without DST were 89%, 75% & 67% respectively. The difference of these GS was not significant (Log rank = 0.20). These data showed that T cell sensitization rate is low (3%), with one PT being denied a living donor kidney. B cell sensitization due to DST is not detrimental to the GS. PTs with DST have impressive long term GS despite their high HLA mismatch score. Because of the small sample size, a possible beneficial effect of the DST cannot be concluded. Since DST protocol implementa-tion is logistically complex, of high cost and subjects patients to T cell sensitization risk, we have decided to discontinue the DST protocol at this Center.