Immunological consequences of past transfusions in kidney transplant candidates: A focus on anti-HLA antibody formation

Perić, Tamara; Vojvodić, Svetlana

doi:10.1016/j.htct.2025.103990

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Original article • Hematol., Transfus. Cell Ther. 47 (4) • 2025 • https://doi.org/10.1016/j.htct.2025.103990 linkcopy

Immunological consequences of past transfusions in kidney transplant candidates: A focus on anti-HLA antibody formation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction Blood transfusions are crucial for saving lives but can affect the recipient's immune system. A significant concern is the development of anti-human leukocyte antigen (HLA) antibodies, which can influence organ transplantation outcomes. The presence of these antibodies increases the risk of transplant rejection. The aim of this study was to evaluate how blood component characteristics (leukodepletion, type, number, volume) and timing from the last transfusion to anti-HLA antibody detection affect sensitization in kidney transplant candidates.

Materials and Methods This retrospective study analyzed 115 candidates on the cadaveric kidney transplant list from South Bačka and Novi Sad, Serbia. Among them, 69 received blood transfusions, classified as either leukodepleted or containing leukocytes (WBCs), for sensitization control. Anti-HLA antibodies were detected using Complement-Dependent Cytotoxicity, Enzyme-Linked Immunosorbent Assay, and Luminex technology. This study evaluated demographic data, transfusion history, and sensitization. Statistical analysis focused on the relationship between sensitization and blood component variables.

Results In this study, 53.7 % were sensitized. The number of blood components received (p-value = 0.437), blood unit (p-value = 0.6809), and blood volume (p-value = 0.5857) were not significantly associated with sensitization rates. The use of leukodepleted blood components (p-value = 0.0057), as well as blood components containing WBCs (p-value = 0.030) is associated with a higher sensitization. Sensitization was detected in 67.57 % of cases more than 12 months after transfusion (p-value = 0.046). A significant difference in sensitization was shown when packed red blood cells were used (89.19 % versus 68.75 %; p-value = 0.006).

Conclusions Sensitization was higher with blood components containing WBCs and packed RBCs. The longer time after transfusion, the more often sensitization is detected.

Keywords
Blood transfusion; Anti-HLA antibodies; Sensitization; Panel reactive antibodies test; Alloimmunization

	Sensitized % (53.7 %)	Non-sensitized % (46.3 %)	p-value
Gender Male Female	40.5 59.5	71.9 28.1	0.015
Age	56.0 (IQR: 19.0)	52.0 (IQR: 19.25)	0.032
ABO type A B AB 0	43.2 21.6 16.2 18.9	50 12.5 6.3 31.3	0.318
RhD type positive negative	59.2 10.8	81.2 18.8	0.496

Variable	Sensitized % (53.7)	Non-sensitized % (46.3)	p-value
ELISA I not valid detected not detected	8.11 45.95 45.95	12.5 0.0 87.5	<0.001
ELISA II not valid detected not detected	8.11 27.03 64.86	12.5 0.0 87.5	0.002
LMX I not valid detected not detected	0.0 81.08 18.92	3.12 0.0 96.88	<0.001
LMX II not valid detected not detected	0.0 59.46 40.54	3.12 0.0 96.88	<0.001

	HLA I	HLA I and II	HLA II	negative	Total	p-value
PRA positive	5 27.78 % 41.67 % 7.25 %	11 61.11 % 57.89 % 15.94 %	0 0.0 % 0.0 % 0.0 %	2 11.11 % 5.88 % 2.9 %	18 26.09 %	<0.001
PRA negative	7 13.73 % 58.33 % 10.14 %	8 15.69 % 42.11 % 11.59 %	4 7.84 % 100.0 % 5.8 %	32 62.75 % 94.12 % 46.38 %	51 73.91 %
Total	12 17.39 %	19 27.54 %	4 5.8 %	34 49.28 %	69 100 %

Variable	Sensitized(53.7 %)	Non-sensitized(46.3 %)	p-value
Number of blood unit received	12.0 (IQR: 36.0)	10.5 (IQR: 16.5)	0.198
Number of blood units received (based on cut off) - % 0-36 >36	29.73 70.27	6.25 93.75	<0.001
Number of blood components received - mean (± SD)	3.19 (± 1.79) Range: (1.0-8.0)	2.97 (± 1.47) Range: (1.0-6.0)	0.696
Number of blood components received (based on cut off) 0-6 >6	10.81 89.19	3.12 96.88	0.106
Volume of blood received (mL)	3520 (IQR: 9859)	2992.5(IQR: 3916.75)	0.226
Volume of blood received in liters (based on cut off) - % 0-11 >11	27.03 72.97	6.25 93.75	0.003
Received blood component with WBCs - % Yes No	89.19 10.81	68.75 31.25	0.006
Received blood component without WBCs - % Yes No	91.89 8.11	96.88 3.12	0.618
Received blood component - % with WBCs without WBCs both	10.81 10.81 78.38	6.25 31.25 62.5	0.011

	<6 month % (29.0)	6-12 month % (7.2)	>12 month % n = (63.8)	p-value
Gender - % male female	55.0 45.0	80.0 20.0	52.27 47.73	0.248
Age - years	51.85 (± 10.89) Range: (31.0-71.0)	53.8 (± 14.2) Range: (28.0-64.0)	53.5 (± 11.55) Range: (35.0-74.0)	0.642
Sensitization - % Yes No	40.0 60.0	80.0 20.0	56.82 43.18	0.046
Number of blood units received	38.05 (± 43.11) Range: (2.0-167.0)	65.4 (± 74.56) Range: (9.0-188.0)	15.3 (± 19.46) Range: (1.0-107.0)	<0.001
Number of blood components received	3.6 (± 1.91) Range: (1.0-8.0)	3.8 (± 1.4) Range: (2.0-6.0)	2.77 (± 1.45) Range: (1.0-6.0)	0.019
Volume of blood received (mL)	11,054.75 (± 12,543.96) Range: (490.0-47,142.0)	18,263.4 (± 20,259.7) Range: (2765.0-50,097.0)	4401.14 (± 6070.36) Range: (165.0-35,083.0)	<0.001
Received blood component - % with WBCs without WBCs both	0.0 40.0 60.0	0.0 0.0 100.0	13.64 13.64 72.73	<0.001

Characteristic of blood components in relation to sensitization
	Odds Ratio	p-value
Intercept
	1.2 (0.546-2.64)	0.649
Number of received blood units
Risk for each 1-unit increase	0.957 (0.775-1.18)	0.681
Number of received blood components
Risk for each 1-unit increase	0.884 (0.649-1.21)	0.437
Received blood volume in milliliters
Risk for each 1-unit increase	1 (0.999-1)	0.586
Type of blood components in relation to sensitization
Intercept
	1.45 (0.969-2.17)	0.0706
Reference: blood components with and without WBCs
blood components containing WBCs	1.38 (0.389-4.89)	0.619
leukodepleted blood components	0.276 (0.111-0.688)	0.005
The effect of the use of packed RBCs on sensitization
Intercept
	0.4 (0.176-0.908)	0.028
packed RBCs
	3.75 (1.52-9.26)	0.004

Variable	Sensitized %(53.7)	Non-sensitized %(46.3)	p-value
Packed RBCs Yes No	89.19 10.81	68.75 31.25	0.006
Leukoreduced RBCs Yes No	40.54 59.46	40.62 59.38	>0.999
Resuspended RBCs depleted of WBCs and platelets Yes No	62.16 37.84	53.12 46.88	0.368
Resuspended RBCs Yes No	62.16 37.84	62.5 37.5	>0.999
Fresh Frozen Plasma Yes No	29.73 70.27	40.62 59.38	0.246
Double Leukoreduced RBCs Yes No	5.41 94.59	3.12 96.88	0.686
Leukoreduced and washed RBCs Yes No	5.41 94.59	3.12 96.88	0.686
Fresh Frozen Plasma without cryoprecipitate Yes No	13.51 86.49	18.75 81.25	0.545
leukocyte-depleted platelets Yes No	2.7 97.3	3.12 96.88	>0.999
preserved whole blood Yes No	8.11 91.89	3.12 96.88	0.285

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