| Summary: | High-volume use of blood transfusion was originally used in attempts to maintain end stage renal disease (ESRD) patients who were anemic with red cell mass ranges of 20 - 25 percent. Due to concerns with transfusion-induced infections such as hepatitis and the production of anti-HLA (human leukocyte antigens) antibodies resulting from the exposure to blood products, efforts were made in the 1970s to avoid the use of blood transfusions in renal transplant recipients. During the pre-cyclosporine era, studies suggested that non-transfused renal graft recipients were at higher risk for graft rejection as compared to those transfused recipients. Subsequently, many studies attempted to define the optimal dose and timing for the transfusion effect. With the introduction of cyclosporine in the early 1980s, leading to improved renal graft and patient survival, the beneficial role of blood transfusions and HLA matching was again being questioned. Meanwhile, some preliminary trials had shown the use of matched pretransplant blood transfusion or donor-specific transfusion (DST) to be beneficial. The evidence supporting the effects (positive, negative, neutral) of pretransplant blood transfusion, regardless of therapeutic or protocol transfusion, in renal transplantation is still not well-established. It is unclear whether the benefits, if any, of pretransplant blood transfusion may be due to the modulation of immune response in which tolerance is induced. This Technology Assessment evaluated data on the impact of red blood cell transfusions on renal allograft outcomes
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