Shared HLA Specificities between the Blood and Transplant Donor Increases the Risk of De Novo DSA Development Following Blood Transfusion in Transplant Recipients

S. Hassan,¹ F. Regan,² C. Brown,³ A. Harmer,² N. Anderson,² E. Santos,⁴ P. Brookes,⁴ D. Taube,¹ M. Willicombe.¹

¹Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom
²Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
³Histocompatibility and Immunogenetics, NHS Blood and Transplant, London, United Kingdom
⁴Histocompatibility and Immunogenetics, Imperial College Healthcare NHS Trust, London, United Kingdom.

Meeting: 2018 American Transplant Congress

Abstract number: 496

Keywords: Blood transfusion, Donor specific transfusion, HLA antibodies, HLA matching

Session Information

Session Name: Concurrent Session: Biomarkers, Immune Monitoring and Outcomes: Clinical

Session Type: Concurrent Session

Date: Tuesday, June 5, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 4:54pm-5:06pm

Location: Room 602/603/604

Introduction: Blood transfusions post-transplant have been shown to be associated with the development of de novo DSA and inferior allograft outcomes. The mechanisms behind this phenomenon are not understood.

Methods: We performed HLA typing on 244 blood donors of transfusions received by 86 renal transplant recipients. Sequential screening of a de novo alloimmune response against the blood (transfusion specific antibody, TSA) and transplant donor (DSA) was performed and analysed.

Results: TSAs developed against 150/244 (61.5%) blood donors. 80/150 (53.3%) were TSAs alone, whilst 70/150 (46.7%) were TSAs in conjunction with DSA. 86/150 (57.3%) TSAs were HLA class I, 35/150 (23.3%) class II and 29/150 (19.3%) class I+II. TSA+DSA- patients were more likely to have class I HLA Abs compared with TSA+DSA+ patients, HR:4.66 (2.0-10.9), p<0.01. There was no difference in the overall ABDR mismatch between the blood donor and recipient in the TSA+ and TSA- groups. However, mismatching between the blood donor and recipient at HLA-B and HLA-DQ was higher in TSA+ compared with TSA- patients, p=0.02 and 0.014 respectively. Importantly, the ABDR HLA match between the blood and transplant donor was greater in the TSA+DSA+ compared with TSA+DSA- patients, p<0.0001.

There was no difference in the baseline demographics between the TSA+ and TSA- recipients. However, allograft outcomes were inferior in the TSA+ compared with the TSA- group, with an increased risk of graft failure (p=0.007) and AMR (p<0.001).

Discussion: This study provides important novel evidence for the benefit of HLA selected blood in transplant patients requiring transfusion. An alloimmune response against the blood donor is common despite immunosuppression. Shared HLA specificities on the blood and transplant donor may provide a greater antigenic stimulus for antibody development and should be avoided.

CITATION INFORMATION: Hassan S., Regan F., Brown C., Harmer A., Anderson N., Santos E., Brookes P., Taube D., Willicombe M. Shared HLA Specificities between the Blood and Transplant Donor Increases the Risk of De Novo DSA Development Following Blood Transfusion in Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Hassan S, Regan F, Brown C, Harmer A, Anderson N, Santos E, Brookes P, Taube D, Willicombe M. Shared HLA Specificities between the Blood and Transplant Donor Increases the Risk of De Novo DSA Development Following Blood Transfusion in Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/shared-hla-specificities-between-the-blood-and-transplant-donor-increases-the-risk-of-de-novo-dsa-development-following-blood-transfusion-in-transplant-recipients/. Accessed May 15, 2025.

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