Shared alloimmune responses against blood and transplant donors result in adverse clinical outcomes following blood transfusion post–renal transplantation

Hassan, Sevda; Regan, Fiona; Brown, Colin J.; Harmer, A.; Anderson, N. A.; Beckwith, Hannah; Roufosse, Candice; Santos‐Nunez, Eva; Brookes, Paul; Taube, David; Willicombe, Michelle

doi:10.1111/ajt.15233

Cited by 37 publications

(56 citation statements)

References 33 publications

(53 reference statements)

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“…Additionally, there is a theoretical risk that the use of CCP may treat or prevent COVID‐19 disease in a way that mitigates the native humoral immune response, leaving these individuals vulnerable to subsequent reinfection 19 . Furthermore, for solid organ transplant recipients in particular, there is some evidence of a risk of developing donor‐specific antibodies (and subsequent antibody mediated rejection) after receiving allogeneic blood products, 20 but this risk is likely very low with CCP given the expected minimal HLA antigen load in a single‐donor plasma product.…”

Section: Discussionmentioning

confidence: 99%

Successful recovery from COVID‐19 in three kidney transplant recipients who received convalescent plasma therapy

Naeem

Gohh

Bayliss

et al. 2020

Transplant Infectious Dis

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Novel coronavirus disease 2019 (COVID‐19) is a highly infectious, rapidly spreading viral disease that typically presents with greater severity in patients with underlying medical conditions or those who are immunosuppressed. We present a novel case series of three kidney transplant recipients with COVID‐19 who recovered after receiving COVID‐19 convalescent plasma (CCP) therapy. Physicians should be aware of this potentially useful treatment option. Larger clinical registries and randomized clinical trials should be conducted to further explore the clinical and allograft outcomes associated with CCP use in this population.

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Section: Discussionmentioning

confidence: 99%

Successful recovery from COVID‐19 in three kidney transplant recipients who received convalescent plasma therapy

Naeem

Gohh

Bayliss

et al. 2020

Transplant Infectious Dis

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“…Similarly, a more recent study by Hassan et al 20 found posttransplant blood transfusion to be associated with a higher risk of allograft failure, all rejection, and de novo DSA formation. Their study also suggested that posttransplant blood transfusion could evoke de novo DSAs.…”

Section: Discussionmentioning

confidence: 78%

“…These reports had conflicting results in terms of the risk for acute rejection and graft and patient survival. [16][17][18][19][20] Therefore, we aimed to evaluate whether the transfusion of blood products was indeed associated with an increased risk for acute rejection, graft loss, or death by any cause in nonsensitized kidney transplant recipients on maintenance immunosuppressive therapy.…”

mentioning

confidence: 99%

Early Posttransplant Blood Transfusion and Risk for Worse Graft Outcomes

Daloul

Braga

Diez

et al. 2021

Kidney International Reports

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Introduction: Blood transfusion is a risk factor for allosensitization. Nevertheless, blood transfusion posttransplant remains a common practice. We evaluated the effect of posttransplant blood transfusion on graft outcomes. Methods: We included nonsensitized, first-time, kidney-alone recipients transplanted between 1 July 2015 and 31 December 2017. Patients were grouped based on receiving blood transfusion in the first 30 days posttransplant. The primary end point was a composite outcome of biopsy-proven acute rejection, death of any cause, or graft failure in the first year posttransplant. Secondary outcomes included the individual components of the primary outcome and the cumulative incidence of de novo donor-specific antibodies (DSAs). Results: Two hundred seventy-three patients were included. One hundred twenty-seven (47%) received blood transfusion. Patients in the transfusion group were more likely to be older, have had a deceased donor, and have received induction with basiliximab. There was no difference between groups in the composite primary outcome (adjusted hazard ratio ¼ [HR] 1.34; 95% confidence interval [CI], 0.83-2.17; P ¼ 0.23). The cumulative incidence of de novo DSAs during the first year posttransplant was similar between groups (12.8% transfusion vs. 10.9% no transfusion, P ¼ 0.48). Conclusion: Early transfusion of blood products in kidney transplant recipients receiving induction with lymphocyte depletion was not associated with an increased hazard of experiencing acute rejection, death from any cause, or graft loss.

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“…Although blood transfusion pre-transplantation is generally avoided due to the risk of sensitization, there remains debate on its impact [ 12 ]. The effect of transfusion post transplantation (with a functioning graft) is less well studied but is thought to increase the risk of developing a DSA [ 19 ]. Interestingly, the incidence of de novo DSA development in this cohort was no higher with EBT than without it.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion

et al. 2020

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There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4–12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection.

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Shared alloimmune responses against blood and transplant donors result in adverse clinical outcomes following blood transfusion post–renal transplantation

Cited by 37 publications

References 33 publications

Successful recovery from COVID‐19 in three kidney transplant recipients who received convalescent plasma therapy

Successful recovery from COVID‐19 in three kidney transplant recipients who received convalescent plasma therapy

Early Posttransplant Blood Transfusion and Risk for Worse Graft Outcomes

Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion

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