EVALUATION OF THE BLOOD TRANSFUSION POLICY OF THE NORTH ITALY TRANSPLANT PROGRAM

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Abstract
A retrospective investigation carried out on the results of the 319 first cadaver kidney transplants performed in the North Italy Transplant Program (NITP) indicated that graft survival was significantly better in transfused than in nontransfused patients (64% vs. 47% at 2 yr, P < 0.05) and was particularly good (80% at 3 yr) in those transfused patients who had not produced lymphocytotoxic antibodies even if the HLA match was not particularly good. These data prompted a transfusion policy: the patients receive 3 U of packed red blood cells at 15 day intervals. A good HLA match is mandatory only for immunized recipients. This policy was expected to improve the results of the transplantation program while reducing the costs of organ sharing. The results of the 165 cadaver kidney transplants confirmed the expectation. Kidney graft survival has increased significantly (from 50-65% at 2 yr); in transfused patients it is close to 70% as expected. Kidney graft survival is better in transfused non-immunized patients than in those who have produced lymphocytotoxic antibodies (71% vs. 62% at 2 yr). A good HLA-A,B match seems important, particularly for immunized recipients. No firm conclusion can still be drawn insofar as the influence of the HLA-DR match on graft survival is concerned. A positive B cell crossmatch (carried out at 22.degree. C after platelet absorption) seems to have a detrimental effect on graft survival. Preoperative transfusion, if effective, is not as effective as pretransplant transfusions in improving the graft survival. The incidence of immunized recipients after 3 deliberate transfusions is acceptable, but because of the unrestricted use of blood transfusions in dialysis units (in addition to those given deliberately), the incidence of immunized and hyperimmunized patients in the waiting list is growing and this is particularly evident in female patients with previous pregnancies. The liberal use of blood transfusions must be halted to prevent an ever higher proportion of patients to become excluded from transplantation.