TRANSFUSION-INDUCED HLA SENSITISATION IN WAITLIST PATIENTS AND KIDNEY TRANSPLANT RECIPIENTS.

Abstract

HLA sensitisation remains an impediment to successful solid organ transplantation, whether it be chances of receiving a transplant offer or subsequent transplant longevity. Current treatments targeting HLA antibodies lack long term effectiveness, therefore preventing HLA sensitisation should remain a priority in all potential waitlist candidates and transplant recipients. Recent advances in the management of anaemia in patients with chronic kidney disease may reduce the need for red cell transfusions. However, data from several anaemia intervention studies of novel therapeutic agents have shown that a need for transfusion will remain. It has also been increasingly recognised that blood transfusions following kidney transplantation, especially in the peri-operative period, are common. Routine data on transfusion incidence, indications and outcomes, is not captured by most kidney and transplant registries across the globe. This restricts the evidence to inform both clinicians and patients on the clinical effects of transfusion, which have been considered both an allogeneic stimulus and to be immunomodulatory. This review aims to provide an update on what is currently known about transfusion-induced HLA sensitisation in waitlist candidates and transplant recipients, summarises where evidence is lacking and demonstrates the distinct need for patient blood management guidelines in the field of kidney transplantation.