Allosensitization Rate of Male Patients Awaiting First Kidney Grafts After Leuko-Depleted Blood Transfusion
Allosensitization Rate of Male Patients Awaiting First Kidney Grafts After Leuko-Depleted Blood Transfusion
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DOI：
10.1097/tp.0b013e3182419864
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发表时间：
2012-02-27
期刊：
影响因子：
6.2
通讯作者：
Ashman, Neil
中科院分区：
文献类型：
--
作者：
Balasubramaniam, Gowrie S.;Morris, Matthew;Ashman, Neil
背景。由于人类白细胞抗原（HLA）异敏化的风险，一般避免输血。尽管促红细胞生成剂的使用几乎是普遍的，但仍有患者由于对促红细胞生成剂的抵抗或心血管不稳定等原因需要输血。肾脏患者异位敏化的风险被认为与白细胞减少的血液较低。我们试图用敏感的固相抗体检测方法，量化在第一次肾移植等待名单上的男性肾脏患者输血本身的风险。横断调查观察HLA抗体在等待首次肾移植的男性患者中使用单抗原Luminex珠检测的流行程度。在我们的等待名单上，有116名男性患者在等待他们的第一次肾脏移植。42例患者中有7例（16.7%）接受了至少一个单位的白细胞减少血液后产生HLA抗体（HLAab）。在其余74例无输血史的患者中，3例（4.1%）发现有hla。所鉴定的抗体均针对I类抗原。有输血史的患者发生hla的相对危险度为4.1 （P = 0.02）。等待第一次器官移植的男性患者与没有输血史的患者相比，有输血史的患者发生HLA抗体的风险增加了四倍。即使在白质耗竭后的时代，输血仍然会造成显著的致敏风险。
Background. Blood transfusions are generally avoided for potential renal transplant recipients due to risk of human leukocyte antigen (HLA) allosensitization. Despite the near universal use of erythropoiesis-stimulating agents, there are still occasions when patients require blood transfusions for reasons such as resistance to erythropoiesis-stimulating agents or cardiovascular instability. The risk of allosensitization in renal patients is believed to be lower with leuko-depleted blood. We sought to quantify the risk of blood transfusion per se in male renal patients on the transplant waiting list for their first kidney graft, using sensitive solid phase antibody detection.Method. Cross-sectional survey looking at the prevalence of HLA antibody detected using single antigen Luminex beads in male patients awaiting first renal transplantation.Results. One hundred sixteen male patients awaiting their first kidney transplant were identified on our waiting list. Seven of the 42 patients (16.7%) who received at least one unit of leuko-depleted blood developed HLA antibody (HLAab). Of the remaining 74 patients without a history of transfusion, 3 (4.1%) were found to have HLAab. All the antibodies identified were directed against class I antigens. A history of blood transfusion gave a relative risk of 4.1 of developing HLAab (P = 0.02).Conclusion. Male patients awaiting their first organ transplant had a fourfold increased risk of developing HLA antibody if they had been previously transfused when compared with those who did not have a history of a transfusion. Transfusion even in the postleukodepletion era continues to pose a significant risk of sensitization.