A randomized study comparing leukocyte-depleted versus packed red cell transfusions in prospective cadaver renal allograft recipients

A prospective randomized study at a single renal transplant center between 1980 and 1982 compared the influence of leukocyte-depleted versus packed red cell pretransplantation blood transfusions on patient sensitization to leukocyte (HLA) antigens, likelihood of receiving a graft, and eventual transplantation results. All consenting potential cadaver renal transplant recipients (n = 107) were randomly assigned to receive transfusions at 6-week intervals with either packed red cells (Group 1) or leukocyte-poor red cells (Group 2) until they were transplanted. Actuarial graft and patient survival were identical for graft recipients in both groups. Although the likelihood of receiving a graft was associated with the level of pretransplant sensitization to leukocyte (HLA) antigens (p <0.02) as measured by the percent of panel reactive antibody (PRA), it was not associated with the type of blood used. The highest mean peak reactive PRA level for all patients showed a low but significant increase (29 ± 4 versus 43 ± 5%; p <0.0005) following entry into the transfusion protocol, but the rate of increase was the same for patients in both treatment groups. The likelihood of receiving a transplant was primarily associated with a history of prior graft rejection (p <0.05), and patients with prior graft loss had the greatest increase in sensitization following entry into the transfusion protocol. These findings indicate that using leukocyte-poor red cells for pretransplant transfusions provided no added benefit when compared with packed red cells in terms of patient sensitization, the likelihood of receiving a transplant, or eventual graft survival.