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Abstract: PO2129

HLA Antibody Elevation Following Red Blood Cell Transfusions in CKD: Results from the START-CKD Trial

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Weir, Matthew R., University of Maryland Baltimore, Baltimore, Maryland, United States
  • Petersen, Jeffrey, AMGEN, Thousand Oaks, California, United States
  • Toto, Robert D., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Berns, Jeffrey S., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Tran, Qui, AMGEN, Thousand Oaks, California, United States
  • Butler, Carrie L., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Valenzuela, Nicole M., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Red blood cell (RBC) transfusion avoidance wherever possible is recommended in kidney transplant candidates in order to prevent the risk of allosensitization. We have previously reported allosensitization following RBC transfusions in dialysis patients with anemia and advanced CKD, but no study has addressed allosensitization in patients with CKD not on dialysis. The START-CKD trial evaluated an ESA treatment on the incidence of RBC transfusions in anemic CKD subjects. This study prospectively collected transfusion data along with antibody (Ab) samples. We hypothesized that RBC transfusions would be associated with: a) development of de novo Abs, b) increase in relative strength of existing HLA Abs, and c) increase in calculated panel reactive Ab (cPRA).


We used two different cohort designs: matched cohort containing subjects with RBC transfusion in between 2 HLA Ab samples, versus subjects with 2 HLA Ab samples without intervening RBC transfusion event. Each transfused subject was matched with up to 2 non-transfused subjects with 4 variables. The second identified cohort consisted of cross-over subjects with longitudinal pre- and post-transfusion Ab samples allowing the subject to serve as their own control. In total, 476 samples from 211 subjects were tested for Ab reactivity to HLA by LabScreen single antigen (OneLambda).


We identified 72 transfused and 124 matched non-transfused patients, and 54 crossover transfused patients. A greater proportion of patients experienced changes in MFI ≥ 25% for class I and ≥ 30% for class II antigens in the transfused compared with non-transfused patients in both matched (any change, 25% vs 7%; significant change, 24% vs 3%) and cross-over cohorts (any change, 19% vs 9%; significant change, 17% vs 2%). In the matched and cross-over cohorts, positive cPRA change occurred in 19% and 11% of transfused subjects, respectively, vs 5% and 6% of non-transfused subjects respectively.


RBC transfusion in patients with anemia and advanced CKD not on dialysis was associated with new HLA antibody development, increased risk of relative strength of antibodies and higher cPRA. These findings establish an important causal relationship between RBC transfusions and clinically relevant HLA Ab development for the first time in this population.


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