Pediatr Nephrol DOI 10.1007/s00467-014-2823-6
ORIGINAL ARTICLE
Washing red cells after leucodepletion does not decrease human leukocyte antigen sensitization risk in patients with chronic kidney disease Antony Aston & Rebecca Cardigan & Saber Bashir & Susan Proffitt & Helen New & Colin Brown & Ri Liesner & Sylvia Hennem & Helen Nulty & Olivia Shaw & Robert Vaughan & Jon Jin Kim & Lesley Rees
Received: 21 February 2014 / Revised: 11 March 2014 / Accepted: 2 April 2014 # IPNA 2014
Abstract Background Standard leucodepleted blood transfusions can induce the production of human leukocyte antigen (HLA)-specific antibodies, which are associated with longer transplant waiting times and poorer graft outcomes. We hypothesized that additional washing of leucodepleted red cells might reduce antigenic stimulus by removal of residual leukocytes and soluble HLA. Methods A retrospective review of HLA antibodies in children with chronic kidney disease stage 4–5 who had ≥two HLA antibody screens between 2000 and 2009, pre- and posttransfusion, and were HLA antibody-negative at first testing. Patients were divided according to whether they received standard leucodepleted blood or “washed cells”. To assess the A. Aston : J. J. Kim : L. Rees Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK R. Cardigan : S. Bashir : S. Proffitt Components Development Laboratory, NHS Blood and Transplant, Brentwood, London, UK H. New : C. Brown NHS Blood and Transplant, London, UK R. Liesner : S. Hennem : H. Nulty Blood Transfusion Laboratory, Great Ormond Street Hospital for Children, London, UK O. Shaw : R. Vaughan Clinical Transplantation Laboratory, GSTS, London, UK
efficacy of washing methods, total leukocytes were enumerated pre- and post- manual and automated washing of standard leucodepleted red cells that had been supplemented with whole blood to achieve measurable leukocyte levels pre-washing. Results A total of 106 children were included: 23 received no blood transfusions (group 1), six had washed cells only (group 2), 59 had standard transfusions only (group 3), and 18 had both standard and washed cells (group 4). Sensitization rates were 26, 17, 44, and 44 % in groups 1–4 (p=0.32). Patients in groups 3 and 4 had more transfusions with red cells, platelets, and plasma products. There was no difference in HLA sensitization risk with washed or standard red cells on analysis of co-variance controlling for platelets and plasma transfusions. The red cell washing study showed no significant reduction in leukocytes using manual methods. Although there was a statistically significant reduction (33 %) from baseline pre-washing using the automated method, from 6.54±0.84 × 106 to 4.36±0.67 × 106 leukocytes per unit, the majority of leukocytes still remained. Conclusions There was no evidence that using washed leucodepleted red cells reduced patient HLA sensitization rates. Washing leucodepleted red cells is unlikely to reduce the risk of HLA sensitization due to the limited effect on residual leukocytes. Keywords Chronic kidney disease . Transplantation . HLA . Alloimmunization . Antibody . Transfusion . Blood product . Components
J. J. Kim MRC Centre for Transplantation, Guys Hospital, London, UK L. Rees (*) Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK e-mail: [email protected]
Introduction Antibodies specific for human leukocyte antigens (HLA) are a significant barrier to transplantation. They are implicated in
Pediatr Nephrol
both acute and chronic graft rejection when directed against donor HLA and result in longer waiting times on the transplant list because of the added difficulty in finding a compatible graft [1]. It has been reported that
ORIGINAL ARTICLE
Washing red cells after leucodepletion does not decrease human leukocyte antigen sensitization risk in patients with chronic kidney disease Antony Aston & Rebecca Cardigan & Saber Bashir & Susan Proffitt & Helen New & Colin Brown & Ri Liesner & Sylvia Hennem & Helen Nulty & Olivia Shaw & Robert Vaughan & Jon Jin Kim & Lesley Rees
Received: 21 February 2014 / Revised: 11 March 2014 / Accepted: 2 April 2014 # IPNA 2014
Abstract Background Standard leucodepleted blood transfusions can induce the production of human leukocyte antigen (HLA)-specific antibodies, which are associated with longer transplant waiting times and poorer graft outcomes. We hypothesized that additional washing of leucodepleted red cells might reduce antigenic stimulus by removal of residual leukocytes and soluble HLA. Methods A retrospective review of HLA antibodies in children with chronic kidney disease stage 4–5 who had ≥two HLA antibody screens between 2000 and 2009, pre- and posttransfusion, and were HLA antibody-negative at first testing. Patients were divided according to whether they received standard leucodepleted blood or “washed cells”. To assess the A. Aston : J. J. Kim : L. Rees Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK R. Cardigan : S. Bashir : S. Proffitt Components Development Laboratory, NHS Blood and Transplant, Brentwood, London, UK H. New : C. Brown NHS Blood and Transplant, London, UK R. Liesner : S. Hennem : H. Nulty Blood Transfusion Laboratory, Great Ormond Street Hospital for Children, London, UK O. Shaw : R. Vaughan Clinical Transplantation Laboratory, GSTS, London, UK
efficacy of washing methods, total leukocytes were enumerated pre- and post- manual and automated washing of standard leucodepleted red cells that had been supplemented with whole blood to achieve measurable leukocyte levels pre-washing. Results A total of 106 children were included: 23 received no blood transfusions (group 1), six had washed cells only (group 2), 59 had standard transfusions only (group 3), and 18 had both standard and washed cells (group 4). Sensitization rates were 26, 17, 44, and 44 % in groups 1–4 (p=0.32). Patients in groups 3 and 4 had more transfusions with red cells, platelets, and plasma products. There was no difference in HLA sensitization risk with washed or standard red cells on analysis of co-variance controlling for platelets and plasma transfusions. The red cell washing study showed no significant reduction in leukocytes using manual methods. Although there was a statistically significant reduction (33 %) from baseline pre-washing using the automated method, from 6.54±0.84 × 106 to 4.36±0.67 × 106 leukocytes per unit, the majority of leukocytes still remained. Conclusions There was no evidence that using washed leucodepleted red cells reduced patient HLA sensitization rates. Washing leucodepleted red cells is unlikely to reduce the risk of HLA sensitization due to the limited effect on residual leukocytes. Keywords Chronic kidney disease . Transplantation . HLA . Alloimmunization . Antibody . Transfusion . Blood product . Components
J. J. Kim MRC Centre for Transplantation, Guys Hospital, London, UK L. Rees (*) Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK e-mail: [email protected]
Introduction Antibodies specific for human leukocyte antigens (HLA) are a significant barrier to transplantation. They are implicated in
Pediatr Nephrol
both acute and chronic graft rejection when directed against donor HLA and result in longer waiting times on the transplant list because of the added difficulty in finding a compatible graft [1]. It has been reported that
