Introduction: HLA sensitization remains a major barrier to successful kidney transplantation resulting in prolonged wait times, lower transplant rates, and decreased graft survival. This study was conducted to determine the association of transfusions with the occurrence, strength, and specificity of HLA antibody formation using highly sensitive and specific methods.

Methods: We linked demographic, comorbidity and transfusion data from the United States Renal Data System (USRDS) with HLA antibody (Ab) data obtained from a pooled antigen assay comprised of Class I antigens only and Class II antigens only on the Luminex® platform for patients (pts) on dialysis awaiting primary kidney transplant. We required patients to have ≥ 2 HLA Ab measurements. We matched pts who had a transfusion event between 2 Ab measurements (transfused group) with up to 4 non-transfused pts each (non-transfused group) by calendar time, age, sex, race, transfusion history, and time on dialysis. We compared changes in adjusted, normalized values for transfused and non-transfused pts using descriptive statistics and logistic regression.

Results: Of 1366 pts with ≥ 2 HLA antibody measurements, there were 90 transfused patients and 259 matched non-transfused patients. The proportion of patients with a significant change in antibody reactivity, defined as changes in adjusted values ≥50 for Class I antigens and ≥60 for Class II antigens, was higher for transfused compared to non-transfused pts (11% vs 1% for Class I; 3% vs 0 for Class II; 13% vs. 1% in either Class I and/or Class II) (Fig 1). Receiving a transfusion was strongly associated with developing a significant antibody response to either Class I or Class II antigens (OR 14.7; 95% CI 3.2-67.2).

Conclusion: Although the incidence of transfusion has decreased with the use of ESAs, these data indicate that transfusion can result in significant increases in HLA Ab strength and specificity.

Figure 1:

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