The effect of blood transfusions on renal transplantation. Studies of 395 patients registered for transplantation with a first cadaveric kidney

Disturbances of acquired immunity in hemodialysis patients

Acquired immunity disturbances in hemodialysis (HD) patients are many and diverse. They are caused by uremia per se, the HD procedure, chronic renal failure complications, and therapeutic interventions for their treatment. Current data suggest that acquired immunity disturbances in HD patients concern mainly the T-lymphocyte and the antigen-presenting cell (APC). The T-lymphocyte-dependent immune response is deficient, predisposing to infections and inadequate response to vaccinations. In addition, APCs are preactivated, which seems to be responsible for the malnutrition-inflammation-atherosclerosis syndrome, and also affects T-lymphocyte function. At the molecular level it is assumed that the interaction between the APC and the T-lymphocyte is impaired. This disturbance is likely to concern the signal that results from the interaction between the major histocompatibility complex:peptide complex on APC surfaces and T-cell receptors on T-lymphocyte surfaces, or the signal that results from the interaction among the co-receptors of these two cells. The aim of the present review was to collect and classify the available clinical and experimental data in this area. Although many pieces are still missing from the puzzle, a better understanding of the responsible molecular mechanisms, will potentially lead to increased survival and a better quality of life in HD patients.

Blood transfusions in renal dialysis patients. Effect on cellular immune response

The effect of blood transfusions, given in low number (less than 5), on the immune response of renal dialysis patients was studied. A significantly lowered response of lymphocytes to mitogen stimulation was observed in patients after as few as one, two or three transfusions, depending on the patient. This led to an increased delta 48/delta 0 ratio reflected by the enhanced response of the cells following delayed addition of suboptimal dose of mitogen. There was no modification of the ratio of helper/inducer to suppressor/cytotoxic T cells subsets (OKT4/OKT8). The use of such simple in vitro tests in a strict protocol of transfusions could allow an adequate follow-up thereby limiting the risks of sensitization. These results demonstrate that important phenomena affecting patients' immune response are turned on following even a low number of transfusions in the majority of uremic patients. This could probably be related to the beneficial effects of blood transfusions on the kidney allograft survival already described.