MULTIVARIATE ANALYSIS OF RISK FACTORS FOR SENSITIZATION AND EARLY REJECTION EPISODES IN A DONOR-SPECIFIC TRANSFUSION PLUS AZATHIOPRINE PROTOCOL

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Abstract
A total of 205 patients who underwent donor-specific transfusions with azathioprine (DST+AZA) treatment from 1982 to 1987 included 25 patients (12%) who developed antibodies cytotoxic to donor T cells (+T warm crossmatch). When we examined a series of 14 variables in relation to the risk of sensitization using a univariate analysis, panel-reactive antibody (PRA) pre-DST of >40%, pregnancy, female sex, male-to-female DST, and HLA antigen match all were significant (P<.05) risk factors. Of these variables, only PRA pre-DST >40% proved to be statistically significant (P<.002) in a multivariate logistic regression model (overall P<.001). Of those patients who went on to transplant with the donor-specific kidney, 41/170 (24%) developed early on or before day 5 posttransplant) rejection episodes. Univariate analysis of 17 variables in relation to early (P=.09), HLA match (P<.004), perioperative transfusions (P<.05), and azathioprine withdrawal for >1 week during DST (P<.05) all correlated with the incidence of early rejection episodes. In a smaller multivariate model involving 47 patients for whom MLC/blocking factor data were available, the presence of plasma blocking factor at the time of transplant was associated with a decreased incidence of early rejection (P=.07). We conclude that the factors that influence the rate of T+ sensitization are distinct from those that influence the rate of early rejection episodes in a DST+AZA protocol.