COMPARATIVE EFFECTS OF PREGNANCY, TRANSFUSION, AND PRIOR GRAFT REJECTION ON SENSITIZATION AND RENAL TRANSPLANT RESULTS

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Abstract
An analysis of all 2879 cadaveric donor transplants performed during the Southeastern Organ Procurement Foundation (SEOPF) USA, Prospective Study from June 1977-Oct. 1981 was performed to determine the relative effects of previous pregnancy, pretransplant transfusion and previous grafting on patient sensitization and renal transplant results. Previous transplantation had the greatest quantitative effect on sensitization as measured by percentage of reactive antibody (PRA). Pregnancy had an intermediate effect while transfusion resulted in a very low, but statistically highly significant, increase in PRA levels. The sensitizing effect of transfusion was greatest in previous transplant recipients and minimal in parous females. Actuarial graft survival in males stratified for transfusion, transplant number and PRA level showed significant enhancement in 1st graft recipients associated with transfusion regardless of PRA level. The benefit of transfusion was lower in regrafted recipients with PRA of .ltoreq. 60% and not present at all in those with PRA of > 60%. Prior graft loss did not significantly affect graft survival in unsensitized (PRA = 0) patients, but was associated with decreased graft survival in sensitized patients. Primary graft survival in females stratified by PRA level, transfusion and prior pregnancy revealed a mildly detrimental effect of pregnancy in untransfused females, and no beneficial effect of pretransplant transfusion in nonpregnancy females. Prior pregnancy appeared to be beneficial in transfused females and transfusion was beneficial in previously pregnant females. Untransfused females without prior pregnancy had significantly better graft survival than untransfused males, irrespective of PRA level. The effect of sensitization on graft survival stratified for transfusion, prior pregnancy and previous transplantation was of significant detriment only in transfused, regrafted males and transfused, previously pregnant females. The study, while limited only to patients who received transplants, indicates that transfusion, prior pregnancy and previous transplantation should be considered as associated variables when their effects on sensitization and graft outcome are analyzed.