Evaluation of pre- and posttransplant donor-specific transfusion/cyclosporine A in non-HLA identical living donor kidney transplant recipients

Background. The beneficial effects of donor specific transfusion (DST) have become controversial in the cyclosporine era, This study was performed to evaluate the potential benefits of a new protocol for administering DSTs in the perioperative period. Methods. Non-HLA identical living donor kidney transplant recipients were r andomized prospectively to control or to receive a DST 24 hr before transpl ant and 7-10 days posttransplant, All patients received similar immunosuppr ession according to protocol. Results. The protocol had 212 evaluable patients (115 transfused and 97 con trol). There were no differences in 1- and a-year graft and patient surviva l, causes of graft failure, incidence and types of infection, repeat hospit alization, or the ability to withdraw steroids. Immunological hyporesponsiv eness (by mixed lymphocyte culture) occurred more frequently in transfused patients (18%) than controls (3%) (P=0.04), Blood stored for greater than o r equal to 3 days was associated with fewer early rejections than blood sto red less than or equal to 2 days. Overall, class II antigen mismatches were associated with more rejection episodes than class I antigen mismatches. H owever, transfused patients, but not control patients, with more class I an tigen mismatches were more likely to have rejections. Conclusions. Administration of DSTs by the method described had no practica l influence on patient or graft survival for up to 2 years. However, donor- specific hyporesponsiveness was more common in transfused patients (18 vs. 3%). Longer follow-up will be needed to determine whether DST will be assoc iated with long-term benefit.