Pretransplant blood transfusions with cyclosporine in pediatric renal transplantation |
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Authors: | P Niaudet J Dudley M Charbit M-F Gagnadoux K Macleay M Broyer |
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Institution: | Néphrologie Pédiatrique, H?pital Necker-Enfants Malades, Paris, France, FR
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Abstract: | Pretransplant transfusions were repeatedly shown to be associated with improved graft survival in the ”pre-cyclosporine era,”
and have recently been shown to be beneficial in patients on modern immunosuppressive regimes. In an attempt to improve this
transfusion effect and minimize the potential development of cytotoxic antibodies, we have given these transfusions, with
concomitant cyclosporine cover, prior to transplantation. Ninety-two renal transplantations were performed in 91 children
in the study group (group 1) and all received pretransplant transfusions with cyclosporine cover. Results were compared with
a preceding group of 102 children (104 transplantations) who had received pretransplant transfusions without cyclosporine
cover (group 2). There were 70 cadaver and 22 living-related donor (LRD) transplants in group 1, and 88 cadaver and 16 LRD
transplants in group 2. Graft survival rates (1- and 5-year) for cadaver transplantation were 96% and 90% in group 1 compared
with 78% and 64% in group 2 (P=0.001). For LRD transplantation, these figures were 95% and 87% in group 1 and 81% and 69% in group 2. There was no difference
between the two groups in terms of age at transplantation, sex, donor age, HLA-A, -B, -DR mismatches, or cold and warm ischemia
times. All cadaver graft recipients received quadruple, sequential immunosuppression post transplant. However, 9 patients
in group 1 were changed to tacrolimus for recurrent rejection episodes. No patient developed persistent lymphocytotoxic antibodies
post transfusion or side effects of cyclosporine. Cyclosporine can be safely given with whole blood prior to transplantation
with no adverse effect and no sensitization. Graft survival was significantly improved in this group of patients and graft
loss due to rejection was exceptional. This effect should be further evaluated in prospective studies.
Received: 10 June 1999 / Revised: 9 March 2000 / Accepted: 10 March 2000 |
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Keywords: | Blood transfusion Cyclosporine Renal transplantation Cytotoxic antibodies |
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