Impact of transfusions and acute rejection on posttransplantation donor antigen-specific responses in two study populations. Cooperative Clinical Trial in Transplantation Research Group.
1999 Mar 15
Journal Article
Authors:
Reinsmoen, N.L.;
Matas, A.J.;
Donaldson, L.;
Carter, S.
Secondary:
Transplantation
Volume:
67
Pagination:
697-702
Issue:
5
PMID:
10096524
DOI:
10.1097/00007890-199903150-00009
Keywords:
Azathioprine; Blood Transfusion; Cyclosporine; Graft Rejection; HLA Antigens; Humans; Immunosuppressive Agents; kidney transplantation; Prednisone; Tissue Donors
Abstract:
BACKGROUND: We participated in a protocol supported by the National Institutes of Allergy and Infectious Disease, Cooperative Clinical Trial in Transplantation (CCTT), which was designed to investigate the effect of peritransplant donor-specific transfusion in non-HLA-identical living donor kidney recipients.METHODS: We determined the donor antigen-specific responses at 1 year after transplantation for the 79 CCTT donor-recipient combinations in this study. A lower rate of donor antigen-specific hyporeactivity was seen in the CCTT recipients (6 of 79=8%) versus our recipients at the University of Minnesota who underwent transplantation in the same period (9 of 55=16%, P=0.16) and versus our combined historical data (33 of 131=25%, P=0.002). Therefore, we studied the differences in the two recipient populations to determine why hyporeactivity was lower in the CCTT group than at our center.RESULTS: Significant differences were seen in the acute rejection rates and the frequency of pretransplantation random transfusion. Overall and early (<3 month) acute rejection rates were higher in CCTT versus Minnesota recipients (overall: 51% vs. 20%, P=0.001) (early: 43% vs. 16%, P=0.001). The frequency of pretransplantation random transfusion was 40% for CCTT recipients (34%) versus 80% for Minnesota recipients (75%) (P=0.0004).CONCLUSIONS: These results provide provocative, although not conclusive, evidence for the importance of pretransplantation transfusion and acute rejection episodes in the development of donor antigen-specific hyporeactivity. Pre-, peri-, and posttransplantation clinical events undoubtedly have an impact on posttransplantation immune parameters.
