However during acute illness or surgery patients may still be exposed to blood products, although specifically transfusing patients for immunological benefit is no longer routine [18], [19] and [20]. Leucodepletion of blood products has also been shown not to prevent the risk of allosensitisation associated with RBCT [14], [21], [22] and [23]. The majority of studies on the role of blood transfusion was performed in the period before the use of sensitive and specific solid phase antibody detection assays were available and cell-dependent cytotoxicity assays were utilised.

Although it is established that DSA detected at the time of transplant is associated with an increased risk of AMR why some patients with DSA develop AMR and others do not is unclear and may relate to variability in the antibody sub-type, complement AZD6244 cell line binding ability, or the amount or breadth of antibody [1], Doxorubicin [24], [25] and [26]. Transfusion in the peri-operative and early post-transplant period depends on individualised patient management factors and is commonly thought not to be an immunological stimulus because it is assumed that the concomitant use of immunosuppression mitigates this risk. We hypothesised

that post-transplant transfusion in patients with preformed HLA antibody may provide additional allostimulation or immunological recall and increase the risk of AMR. We therefore investigated the relationship of pre-transplant and peri-operative transfusion in renal transplant

recipients with and without pre-transplant HLA antibody determined by Luminex single antigen bead (SAB) assay. We studied 258 transplant recipients of which 246 patients old received a kidney transplant and 12 patients received a simultaneous pancreas–kidney transplant between June 2003 and October 2007. Patients were transplanted at 3 tertiary centres and peri-operative care and decision for transfusions was individualised, clinically indicated and not mandated by protocol. No donor-specific transfusions occurred. Leucocyte depleted packed red cells were used. All patients received a calcineurin inhibitor (CNI) (tacrolimus or cyclosporine) at the time of transplantation in combination with mycophenolate mofetil or mycophenolate sodium and corticosteroids and the Interleukin-2 receptor antibody basiliximab was commonly used for induction. The need for biopsy, medication adjustments and transfusion was determined by the caring clinical teams and was not protocol driven. Transfusion history was obtained from the West Australian Red Cross Blood Bank, the Westmead Hospital Transfusion Laboratory, patient medical records and direct patient interrogation. Patient follow-up was a median of 67 months (IQR 54–77). Patients provided written consent for participation in this study. These are reported in detail elsewhere however stored donor DNA was typed by sequence based typing at HLA-A, -B, -C, -DRB1, DQB1, DPB1 loci and DRB3, 4, 5 and DQA1 where required [27].