Incidence, Characteristics, and Outcome of Recipients Sensitized After Donor-Specific Blood Transfusions

One- and 2-year graft survival rates in recipients of kidneys from their blood donors are 98 and 95%, respectively. It is important to separate this favorable effect of donor-specific blood transfusions (DST) from the capacity of DST to immunize potential recipients. One hundred and two patients have completed the DST protocol through April 1981, and this report provides an analysis of antibody responses following DST. Seventy-three percent (66 of 90) of the patients receiving DST prior to primary transplantation were accepted as potential recipients from their blood donor on the basis of a negative T-warm and B-warm donor-specific crossmatch (DSXM). In contrast, only 25% (3 of 12) of the patients receiving DST prior to a second or third transplant had a negative DSXM (P < 0.003). Three patterns of donor-specific sensitization have evolved and are described. Evaluation of the 90 patients who underwent DST before primary transplantation reveals that the 58 potential recipients who received third-party transfusions (TPT) in addition to DST had a significantly higher mean increase in T-warm panel sensitization when compared with the 32 patients receiving DST only (P < 0.01). A significantly greater percentage of positive DSXM patients, when compared with the negative DSXM patients, developed greater than 10% increases in T- and B-warm panel cytotoxins (P < 0.0001). Most patients with greater than 10% increase in T-warm cytotoxins additionally received TPT. Comparison of the DSXM results with parallel panel cytotoxin screening appears to suggest that the same responder to the potential kidney donor also appears to be a general responder to TPT. In those recipients without concomitant TPT, the sensitization to DST was, in general, specific to that blood donor without significant increase in panel cytotoxins. Subsequent cadaver transplantation has not been jeopardized in patients developing a positive DSXM after DST. In summary, the potential benefits of the DST protocol appear to outweigh the minimal risks of possible unfavorable sensitization.