Effect of Blood Transfusions on Survival of Cadaver and Living Related Renal Transplants

SUMMARY The effect of blood transfusion was analyzed in 194 first cadaver renal transplants and 86 living related renal transplants. The association of blood transfusion with HLA genotyping and poor risk recipients was analyzed. Exclusion of poor risk recipients improved graft survival among the transfused group of patients but not in the small subgroup of nontransfused recipients. No effect of blood transfusion was observed in the living related group. Improved graft survival was observed in both the haplotype-matched and nonhaplotype-matched transfused cadaver recipients. The haplotype-transfused recipients had graft survival rates of 69 and 66% at 1 and 2 years, respectively. The greatest beneficial effect was seen in the double haplotype-transfused cadaver recipients with graft survival rates of 80 and 71% for the same period. The lack of beneficial effect of transfusion in the living related patients is felt to be a result of the fact that the maximum effect had already been achieved by a far superior donor-recipient histocompatibility than is able to be achieved in a large group of cadaver recipients The association of pretransplantation blood transfusion and improved cadaver renal allograft survival has now been clearly documented in several single centers as well as in a multicenter study of Opelz and Terasaki (1) We have reported previously that the improved graft survival related to blood transfusions cannot be attributed to other known variables, since stratification of the data for these factors showed that they are not responsible for the beneficial effect (2). In addition, we have presented data suggesting that transfusions given only on the day of transplantation are as beneficial as pretransplant transfusions, and that as few as 3 units achieved the maximum effect (2). This finding has led to our more recent policy of intentional transfusion on the day of transplantation with 3 units of frozen erythrocytes, if the patient has not been transfused previously In another report we observed that cadaver graft survival was improved when patients with severe diabetes mellitus and patients over 50 years were excluded (3). We have also shown that cadaver graft survival was improved when recipients received a haplotype-matched kidney (3, 4). This present study was undertaken to determine the interrelationship of these factors with blood transfusions in first cadaver transplants and living related renal transplants