SENSITIZATION TO HUMAN-LEUKOCYTE ANTIGEN BEFORE AND AFTER THE INTRODUCTION OF ERYTHROPOIETIN

Introduction. Antibodies directed against human leukocyte antigens (HL As) impact adversely on renal transplantation. Measures aimed at preve nting such antibody formation are thus important. The introduction of recombinant human erythropoietin (rHuEpo) has permitted the reduction of blood transfusion in patients with chronic renal failure. The impac t of rHuEpo on the incidence of sensitization in patients awaiting tra nsplantation was therefore studied. Methods. A retrospective analysis of the patients awaiting transplantation before (group A) and 4 years after (group B) the introduction of rHuEpo was performed in order to a scertain changing patterns in the use of blood transfusion and causes of sensitization. Results. The total number of transfusions administer ed to haemodialysis patients decreased by 34% during the study period. This was accompanied by a significant reduction in the ratio of blood transfusion to haemodialysis treatment episodes (0.095 in group A to 0.06 in group B, P=0.001). The number of patients sensitized as a cons equence of blood transfusion decreased from 63% in group A to 28% in g roup B (P=0.0004). The overall incidence of sensitization decreased fr om 50% in group A to 36.5% in group B (P=0.008). This decrement was as sociated with a significant reduction in the mean waiting time for tra nsplantation (42.1 +/- 1.1 vs 15.4 +/- 2.4 months, P<0.0001). The inci dence of sensitization due to previous transplantation increased durin g the study period from 41% in group A to 77% in group B, (P=0.0004). There was no change in the number of patients sensitized due to pregna ncy. Conclusion. The introduction of rHuEpo has resulted in a signific ant decrease in the requirements for blood transfusion among patients awaiting transplantation and is associated with a significant reductio n in transfusion-related sensitization and mean waiting time for trans plantation.