Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts

Jennifer P. Bynum, Andrea Zachary, Paul Michael Ness, Xun Luo, Serena M Bagnasco, Karen Eileen King, Dorry Segev, Babak J. Orandi, Daniel Warren, Alice Fuller, Ana Ciappi, Robert Montgomery, Aaron A Tobian

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Antibody-mediated rejection (AMR) is a major barrier to the long-term function of renal allografts. White blood cells, which may be present in red blood cell (RBC) units, and platelets (PLTs) express HLA antigens that may increase the risk of AMR by inducing or increasing humoral sensitization to HLA. STUDY DESIGN AND METHODS: A retrospective cohort study of HLA-incompatible (HLAi) renal transplant recipients between 2004 and 2015 was conducted. Data on apheresis PLT and leukoreduced RBC transfusions within 4 weeks of transplantation, demographic information, and biopsy-proven AMR were collected from medical records and the Scientific Registry of Transplant Recipients. Patients were evaluated until they showed evidence of AMR or until 1 year posttransplant, whichever came first. Multivariable analysis with Cox modeling was performed. RESULTS: Of 244 individuals, 182 (74.6%) received RBCs and 20 (8.2%) of those also received PLTs. During the first year posttransplant, 97 (39.8%) had AMR. RBC-alone or RBC and PLT transfusions were not associated with increased risk of AMR after adjustment for panel-reactive antibody, years on dialysis, HLA antibody strength, and number of therapeutic plasma exchange treatments (adjusted hazard ratio [adjHR] 1.00, 95% confidence interval [95% CI] 0.59-1.69; and adjHR 0.68, 95% CI 0.28-1.68, respectively). For each 1-unit increase in RBC transfusions, there was no association with AMR (adjHR 0.94, 95% CI 0.85-1.05). Only HLA antibody strength before transplantation was associated with AMR (adjHR 2.23, 95% CI 1.10-4.52; cytotoxic crossmatch compared to crossmatch negative but detectable donor-specific HLA antibodies). CONCLUSIONS: Patients who receive an HLAi transplant who are transfused with leukoreduced RBCs or PLTs in the peritransplant period are at no higher risk of AMR than nontransfused patients.

Original languageEnglish (US)
Pages (from-to)1951-1957
Number of pages7
JournalTransfusion
Volume58
Issue number8
DOIs
StatePublished - Aug 1 2018

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Blood Transfusion
Allografts
Kidney
Antibodies
Erythrocyte Transfusion
Blood Platelets
Confidence Intervals
Transplantation
Erythrocytes
Platelet Transfusion
Blood Component Removal
Plasma Exchange
HLA Antigens
Medical Records
Registries
Dialysis
Leukocytes
Cohort Studies
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts. / Bynum, Jennifer P.; Zachary, Andrea; Ness, Paul Michael; Luo, Xun; Bagnasco, Serena M; King, Karen Eileen; Segev, Dorry; Orandi, Babak J.; Warren, Daniel; Fuller, Alice; Ciappi, Ana; Montgomery, Robert; Tobian, Aaron A.

In: Transfusion, Vol. 58, No. 8, 01.08.2018, p. 1951-1957.

Research output: Contribution to journalArticle

Bynum, Jennifer P. ; Zachary, Andrea ; Ness, Paul Michael ; Luo, Xun ; Bagnasco, Serena M ; King, Karen Eileen ; Segev, Dorry ; Orandi, Babak J. ; Warren, Daniel ; Fuller, Alice ; Ciappi, Ana ; Montgomery, Robert ; Tobian, Aaron A. / Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts. In: Transfusion. 2018 ; Vol. 58, No. 8. pp. 1951-1957.
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title = "Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts",
abstract = "BACKGROUND: Antibody-mediated rejection (AMR) is a major barrier to the long-term function of renal allografts. White blood cells, which may be present in red blood cell (RBC) units, and platelets (PLTs) express HLA antigens that may increase the risk of AMR by inducing or increasing humoral sensitization to HLA. STUDY DESIGN AND METHODS: A retrospective cohort study of HLA-incompatible (HLAi) renal transplant recipients between 2004 and 2015 was conducted. Data on apheresis PLT and leukoreduced RBC transfusions within 4 weeks of transplantation, demographic information, and biopsy-proven AMR were collected from medical records and the Scientific Registry of Transplant Recipients. Patients were evaluated until they showed evidence of AMR or until 1 year posttransplant, whichever came first. Multivariable analysis with Cox modeling was performed. RESULTS: Of 244 individuals, 182 (74.6{\%}) received RBCs and 20 (8.2{\%}) of those also received PLTs. During the first year posttransplant, 97 (39.8{\%}) had AMR. RBC-alone or RBC and PLT transfusions were not associated with increased risk of AMR after adjustment for panel-reactive antibody, years on dialysis, HLA antibody strength, and number of therapeutic plasma exchange treatments (adjusted hazard ratio [adjHR] 1.00, 95{\%} confidence interval [95{\%} CI] 0.59-1.69; and adjHR 0.68, 95{\%} CI 0.28-1.68, respectively). For each 1-unit increase in RBC transfusions, there was no association with AMR (adjHR 0.94, 95{\%} CI 0.85-1.05). Only HLA antibody strength before transplantation was associated with AMR (adjHR 2.23, 95{\%} CI 1.10-4.52; cytotoxic crossmatch compared to crossmatch negative but detectable donor-specific HLA antibodies). CONCLUSIONS: Patients who receive an HLAi transplant who are transfused with leukoreduced RBCs or PLTs in the peritransplant period are at no higher risk of AMR than nontransfused patients.",
author = "Bynum, {Jennifer P.} and Andrea Zachary and Ness, {Paul Michael} and Xun Luo and Bagnasco, {Serena M} and King, {Karen Eileen} and Dorry Segev and Orandi, {Babak J.} and Daniel Warren and Alice Fuller and Ana Ciappi and Robert Montgomery and Tobian, {Aaron A}",
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T1 - Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts

AU - Bynum, Jennifer P.

AU - Zachary, Andrea

AU - Ness, Paul Michael

AU - Luo, Xun

AU - Bagnasco, Serena M

AU - King, Karen Eileen

AU - Segev, Dorry

AU - Orandi, Babak J.

AU - Warren, Daniel

AU - Fuller, Alice

AU - Ciappi, Ana

AU - Montgomery, Robert

AU - Tobian, Aaron A

PY - 2018/8/1

Y1 - 2018/8/1

N2 - BACKGROUND: Antibody-mediated rejection (AMR) is a major barrier to the long-term function of renal allografts. White blood cells, which may be present in red blood cell (RBC) units, and platelets (PLTs) express HLA antigens that may increase the risk of AMR by inducing or increasing humoral sensitization to HLA. STUDY DESIGN AND METHODS: A retrospective cohort study of HLA-incompatible (HLAi) renal transplant recipients between 2004 and 2015 was conducted. Data on apheresis PLT and leukoreduced RBC transfusions within 4 weeks of transplantation, demographic information, and biopsy-proven AMR were collected from medical records and the Scientific Registry of Transplant Recipients. Patients were evaluated until they showed evidence of AMR or until 1 year posttransplant, whichever came first. Multivariable analysis with Cox modeling was performed. RESULTS: Of 244 individuals, 182 (74.6%) received RBCs and 20 (8.2%) of those also received PLTs. During the first year posttransplant, 97 (39.8%) had AMR. RBC-alone or RBC and PLT transfusions were not associated with increased risk of AMR after adjustment for panel-reactive antibody, years on dialysis, HLA antibody strength, and number of therapeutic plasma exchange treatments (adjusted hazard ratio [adjHR] 1.00, 95% confidence interval [95% CI] 0.59-1.69; and adjHR 0.68, 95% CI 0.28-1.68, respectively). For each 1-unit increase in RBC transfusions, there was no association with AMR (adjHR 0.94, 95% CI 0.85-1.05). Only HLA antibody strength before transplantation was associated with AMR (adjHR 2.23, 95% CI 1.10-4.52; cytotoxic crossmatch compared to crossmatch negative but detectable donor-specific HLA antibodies). CONCLUSIONS: Patients who receive an HLAi transplant who are transfused with leukoreduced RBCs or PLTs in the peritransplant period are at no higher risk of AMR than nontransfused patients.

AB - BACKGROUND: Antibody-mediated rejection (AMR) is a major barrier to the long-term function of renal allografts. White blood cells, which may be present in red blood cell (RBC) units, and platelets (PLTs) express HLA antigens that may increase the risk of AMR by inducing or increasing humoral sensitization to HLA. STUDY DESIGN AND METHODS: A retrospective cohort study of HLA-incompatible (HLAi) renal transplant recipients between 2004 and 2015 was conducted. Data on apheresis PLT and leukoreduced RBC transfusions within 4 weeks of transplantation, demographic information, and biopsy-proven AMR were collected from medical records and the Scientific Registry of Transplant Recipients. Patients were evaluated until they showed evidence of AMR or until 1 year posttransplant, whichever came first. Multivariable analysis with Cox modeling was performed. RESULTS: Of 244 individuals, 182 (74.6%) received RBCs and 20 (8.2%) of those also received PLTs. During the first year posttransplant, 97 (39.8%) had AMR. RBC-alone or RBC and PLT transfusions were not associated with increased risk of AMR after adjustment for panel-reactive antibody, years on dialysis, HLA antibody strength, and number of therapeutic plasma exchange treatments (adjusted hazard ratio [adjHR] 1.00, 95% confidence interval [95% CI] 0.59-1.69; and adjHR 0.68, 95% CI 0.28-1.68, respectively). For each 1-unit increase in RBC transfusions, there was no association with AMR (adjHR 0.94, 95% CI 0.85-1.05). Only HLA antibody strength before transplantation was associated with AMR (adjHR 2.23, 95% CI 1.10-4.52; cytotoxic crossmatch compared to crossmatch negative but detectable donor-specific HLA antibodies). CONCLUSIONS: Patients who receive an HLAi transplant who are transfused with leukoreduced RBCs or PLTs in the peritransplant period are at no higher risk of AMR than nontransfused patients.

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