Human leukocyte antigen (HLA) sensitization remains an impediment to successful solid organ transplantation, whether it be chances of receiving a transplant offer or subsequent transplant longevity. Current treatments targeting HLA antibodies lack long-term effectiveness; therefore, preventing HLA sensitization should remain a priority in all potential wait-list candidates and transplant recipients. Recent advances in the management of anemia in patients with chronic kidney disease may reduce the need for red cell transfusions. However, data from several anemia intervention studies of novel therapeutic agents have shown that a need for transfusion will remain. It has also been increasingly recognized that blood transfusions following kidney transplantation, especially in the peri-operative period, are common. Routine data on transfusion incidence, indications, and outcomes are not captured by most kidney and transplant registries across the globe. This restricts the evidence to inform both clinicians and patients on the clinical effects of transfusion, which have been considered both an allogeneic stimulus and to be immunomodulatory.This review aims to provide an update on what is currently known about transfusion-induced HLA sensitization in wait-list candidates and transplant recipients, summarizes where evidence is lacking, and demonstrates the distinct need for patient blood management guidelines in the field of kidney transplantation.

中文翻译：

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输血诱导的 HLA 在等待名单患者和肾移植受者中的致敏作用


人类白细胞抗原 （HLA） 致敏仍然是实体器官移植成功的障碍，无论是获得移植报价的机会还是随后的移植寿命。目前针对 HLA 抗体的治疗缺乏长期疗效;因此，预防 HLA 致敏仍应成为所有潜在候补名单候选者和移植受者的优先事项。慢性肾病患者贫血管理的最新进展可能会减少对红细胞输注的需求。然而，来自新型治疗药物的几项贫血干预研究的数据表明，输血需求仍然存在。人们也越来越认识到，肾移植后输血，尤其是在围手术期，很常见。全球大多数肾脏和移植登记处均未捕获有关输血发生率、适应证和结果的常规数据。这限制了告知临床医生和患者输血临床效果的证据，输血既被认为是同种异体刺激又是免疫调节。本综述旨在提供目前已知的关于等待名单候选人和移植受者输血诱导的 HLA 致敏的最新信息，总结缺乏证据的地方，并证明肾移植领域对患者血液管理指南的明确需求。