Blood Transfusions in Organ Transplant Patients: Mechanisms of Sensitization and Implications for Prevention

Sensitization by previous pregnancies or transplants is considered unavoidable, but it is transfusions given to these patients that leads most often to broad sensitization. Both leukocytes and red cells carry a significant HLA antigen load, and residual leukocytes and/or red cell HLA may explain why...

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Bibliographic Details
Published in:American journal of transplantation 2011-09, Vol.11 (9), p.1785-1791
Main Authors: Scornik, J. C., Meier‐Kriesche, H.‐U.
Format: Article
Language:English
Subjects:
Autoantibodies - blood
Biological and medical sciences
Female
HLA antibodies
HLA Antigens - immunology
Humans
Immunosuppressive Agents - therapeutic use
Medical sciences
Organ Transplantation
organ transplants
Pregnancy
Pregnancy Complications
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Assessment
sensitization
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Transfusion Reaction
transfusions
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Summary:Sensitization by previous pregnancies or transplants is considered unavoidable, but it is transfusions given to these patients that leads most often to broad sensitization. Both leukocytes and red cells carry a significant HLA antigen load, and residual leukocytes and/or red cell HLA may explain why leukocyte‐reduced units are unable to prevent sensitization to any significant degree. Prevention of sensitization will require a more active effort to avoid blood transfusions, whenever possible. When transfusions are required, there is evidence that the use of HLA‐matched blood or immunosuppression in selected situations may reduce sensitization, even in patients previously exposed to alloantigens. These additional measures are not logistically straightforward or devoid of risks and need to be confirmed by rigorous studies. However, remaining as passive observers when patients become broadly sensitized should no longer be considered an acceptable alternative for potential transplant recipients. Broad sensitization often results from an interplay between blood transfusions and previous pregnancies or transplants, making prevention strategies complex but worthwhile.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2011.03705.x