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Impact of Blood Transfusions After Kidney Transplantation on Clinical Outcomes and Broadness of Sensitisation

Year: 2026

Type: article

Abstract: Whether erythrocyte transfusion (ET) after kidney transplantation triggers formation of de novo donor-specific HLA-antibodies (HLA-DSA) and rejection remains debated. If this were true, ET should broaden HLA sensitisation, reflected by increased calculated panel reactive antibodies (cPRA) and de novo HLA-antibody specificities beyond HLA-DSA. This has not been investigated in detail yet. In this retrospective study we included 519 kidney transplant recipients having single antigen bead analyses pretransplant and at one-year posttransplant. ET was assessed both as a binary variable (with/without ET) and in quantity-based groups (without ET, 1-2 ET, 3-5 ET, > 5 ET). No significant differences were found between patients with/without ET in the one-year incidence of clinical rejection (19.7% vs. 15.3%, p = 0.43), clinical/subclinical rejection (30.0% vs. 28.6%, p = 0.86), TCMR (15.6% vs. 19.4%; p = 0.30) and AMR (15.6% vs. 10.1%; p = 0.19). Quantity-based analysis also showed no significant differences, except for higher AMR incidence in patients receiving > 5 ET (p = 0.03). This association lost significance after multivariable adjustment in a time-dependent Cox model (HR: 0.91 [95%-CI: 0.52-1.59]; p = 0.74). De novo HLA-DSA incidence was similar in patients with/without ET (3.5% vs. 3.1%, p = 0.80) and across quantity-based groups (p = 0.17). cPRA change did not differ between patients with/without ET or across quantity-based groups. No preferential sensitisation against highly prevalent HLA-antigens Class I was observed (e.g., HLA-A1 [0.4%], HLA-A2 [0.8%], HLA-B51 [0.8%] and HLA-Cw7 [1.3%]). In conclusion, ET after kidney transplantation under tacrolimus/mycophenolate/prednisone-based immunosuppression was not associated with rejection, de novo HLA-DSA formation, and broadened HLA sensitisation arguing against the clinical need for HLA-matched/selected ET in this setting.

Source: HLA

DOI: 10.1111/tan.71068