BLOOD TRANSFUSIONS AND HLA MATCHING—AN EITHER/OR SITUATION IN CADAVERIC RENAL TRANSPLANTATION1 Pressented at the 6th Annual Meeting of the American Society of Transplant Physicians, May 1987, Chicago, IL

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Cyclosporine-treted recipients of primary cadaver donor renal transplants had a one-year graft survival rate of 79% if they received pretransplant blood transfusions (n=5308). The one-year survival rate for non-transfused recipients (n=709) was significantly lower at 69% (P<0.001). The transfusion effect was larger in black reciopients (a 17% difference) than in white recipients (5%). The effect was also larger in recipients of grafts poorly matched for HLA-A, B, -B, DR, or -DR antigens than in recipients of well-matched grafts. Transfusions did not dignificantly improve graft survival in recipients with zero or one HLA-A, B or -B, DR, or zero-DR-mismatched grafts. However, transfusions accounted for increased of 10%, 14%, adn 17% in patients receiving grafts mismatched at 2, 3, or 4 HLA-B, DR antigens,l respectively. Several factors including cyclosporine and HLA matching have contributed to improving graft survival rates in nontransfused revcipients. Sensitization was noted in 20% of transfused patients awaiting primary renal transplnats in Southern California, as compared with 10% in transplanted patients, suggesting a tendencey to transplant nonsensitized patients. Of the sensitized patients, 75% were female. Based on these date, we suggest that high survival of primary kidney allografts in th ecyclosporine era can best be maintained by the continued use f pretransplant transfusions for the majority of recipients— or, alternatively, by HLA matching for patients who are at higher risk of becoming sensitized

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