Abstract
In patients treated with conventional immunosuppression (azathioprine and prednisone) after renal transplantation, there is a beneficial effect of pre-transplant blood transfusions on graft survival; in patients treated with cyclosporine, this effect may be lost. In 66 children who received living-related donor transplants after donor-specific transfusions (DST) and were treated with azathioprine-prednisone in our center, 1- and 5-year graft survival rates were 99% and 77% respectively. These rates were similar to those reported for children who did not receive DST but were treated with cyclosporine in other centers. There were 634 adult and pediatric recipients of cadaver transplants in our center who were treated with cyclosporine and prednisone (non-sequential therapy,n=89) or antilymphoblast globulin, azathioprine preduisone, and cyclosporin (sequential therapy,n=545). When all patients were considered, graft survival rates were higher in transfused than in non-transfused patients at 3–5 years, but in the sequential therapy group, there were no differences in graft survival rates between transfused and non-transfused patients. The results suggest that transfusions do not improve cadaver graft survival in patients receiving optimal cyclosporine therapy and that equally good related donor graft survival can be achieved with DST and conventional immunosuppression or no DST and cyclosporine.
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References
Opelz G, Sengar DPS, Mickey MR, Terasaki PI (1973) Effect of blood transfusions on subsequent kidney transplants. Transplant Proc 5: 153–259
Salvatierra O, Vincenti F, Amend W, Potter D, Iwaki Y, Opelz G, Terasaki P, Duca R, Cochrum K, Hanes D, Stoney RJ, Feduska NJ (1980) Deliberate donor-specific blood transfusions prior to living related renal transplantation: a new approach. Ann Surg 192: 543–551
Solheim BG, Flatmark A, Halvorsen S, Jervell J, Pape J, Thorsby E (1980) Effect of blood transfusions on renal transplantation: study of 191 consecutive first transplants from living related donors. Transplantation 30: 281–284
Potter D, Garovoy M, Hopper S, Terasaki P, Salvatierra O (1985) Effect of donor-specific transfusions on renal transplantation in children. Pediatrics 76: 402–405
Garovoy MR, Colombe BW, Melzer J, Feduska N, Shields C, Cross D, Amend W, Vincenti F, Hopper S, Duca R, Salvatierra O (1985) Flow cytometry crossmatching for donor-specific transfusion recipients and cadaveric transplantation. Transplant Proc 17: 693–695
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481
Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50: 163–170
Conley SB, Portman RJ, Lemire JM, Van Buren CT, Lewis R, Kahan BD (1988) Five years' experience with cyclosporine in children. Transplant Proc 20 [Suppl 3]: 280–284
Hoyer PF (1989) Optimal use of cyclosporin A in children (abstract). Pediatr Nephrol 3: C83
Clark AGB, Rigden SPA, Welsh KI, Bewick M, Koffman G, Haycock GB, Chantler C (1989) Renal transplantation in children using cyclosporin A and azathioprine. Transplant Proc 21: 1685–1686
So SKS, Najarian JS, Nevins TE, Fryd DS, Knaak M, Chavers B, Mauer SM, Simmons RKL (1987) Low-dose cyclosporine therapy combined with standard immunosuppression in pediatric renal transplantation. J Pediatr 111: 1017–1021
Broyer M, on behalf of the EDTA Registry Committee (1989) Kidney transplantation in children — data from the EDTA registry. Transplant Proc 21: 1985–1988
Salvatierra O, Vincenti F, Amend W, Garovoy M, Iwaki Y, Terasaki P, Potter D, Duca R, Hopper S, Slemmer T, Feduska N (1983) Four-year experience with donor-specific blood transfusions. Transplant Proc 15: 924–931
Glass NR, Miller DT, Sollinger HW, Belzer FO (1985) A four-year experience with donor blood transfusion protocols for living-donor renal transplantation. Transplantation 36: 615–619
Friedman A, Deierhoi M, Chesney R, Sollinger H, Belzer F (1987) Donor-specific transfusions in renal transplantation in children: effect of azathioprine plus transfusions. Transplantation 44: 159–161
Anderson CB, Jendrisak MD, Flye MW, Hanto DW, Anderman CK, Rodey GE, Sicard GA (1989) Concomitant immunosuppression and donor-specific transfusions prior to renal transplantation. Transplant Proc 21: 1828–1831
Flechner SM, Kerman RH, Van Buren C, Kahan BD (1984) Successful transplantation of cyclosporine-treated haploidentical living-related renal recipients without blood transfusions. Transplantation 37: 73–76
Groth CG, Fehrman I, Ringden O, Lundgren G (1987) Related donor kidney transplantation is the best form of treatment for uremia. Transplant Proc 19: 2278–2279
Sommer BG, Ferguson RM (1985) Mismatched living, related donor renal transplantation: a prospective, randomized study. Surgery 98: 267–274
Salvatierra O (1988) Current strategy for donor-specific blood transfusions including a pre- and post-transplant role for azathioprine. Transplant Proc 20 [Suppl 8]: 37–41
Salvatierra O, Melzer J, Vincenti F, Amend WJC, Tomlanovich S, Potter D, Husing R, Garovoy M, Feduska NJ (1987) Donor-specific blood transfusions versus cyclosporine — the DST story. Transplant Proc 19: 160–166
Cecka JM (1987) The transfusion effect. In: Terasaki PI (ed) Clinical transplants 1986. UCLA Tissue Typing Laboratory, Los Angeles, pp 287
Opelz G, for the Collaborative Transplant Study (1987) Improved kidney graft survival in nontransfused patients. Transplant Proc 19: 149–152
Groth CG (1987) There is no need to give blood transfusions as pretreatment for renal transplantation in the cyclosporine era. Transplant Proc 19: 153–154
Ferguson RM, for the Transplant Information Share Group (TISG) (1988) A multicenter experience with sequential ALG/cyclosporine therapy in renal transplantation. Clin Transplant 2: 285–294
Sommer BG, Henry M, Ferguson RM (1987) Sequential antilymphoblast globulin and cyclosporine for renal transplantation. Transplantation 43: 85–90
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Potter, D.E., Portale, A.A., Melzer, J.S. et al. Are blood transfusions beneficial in the cyclosporine era?. Pediatr Nephrol 5, 168–172 (1991). https://doi.org/10.1007/BF00852877
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DOI: https://doi.org/10.1007/BF00852877