In conclusion, we have shown that Pre-RBCT

alone is still associated with a lower rate of Non-AMR rejection and an increased risk of HLA antibody. However, peri-operative blood transfusion in sensitised renal recipients with DSA and prior transfusion is associated find more with AMR. Post-RBCT may therefore be an additional factor modifying the risk of AMR in patients with HLA-antibody. We also confirm and expand upon the previous findings that perioperative blood transfusion is associated with poorer graft and patient survival, and show that this is most evident in those with previous exposure to RBCT, independent of acute rejection episodes. These findings suggest that RBCT remains a potent and complex modifiable immunomodulator of renal transplant outcomes and additional studies to further define mechanisms for these effects are warranted. This is an original work and the manuscript or parts of it have not been submitted elsewhere for publication. All authors have read and approved submission of the

manuscript, PD0325901 cost and that material in the manuscript has not been published and is not being considered for publication elsewhere in whole or part in any language except as an abstract. The authors wish to acknowledge the clinicians and transplant nurses at Royal Perth Hospital, Sir Charles Gairdner Hospital and Fremantle Hospital in Western Australia involved in the collection of this data. We wish to thank the Department of Clinical Immunology, PIK-5 Royal Perth Hospital for compatibility testing of the patients in this study. “
“Kidney transplantation is the preferred treatment modality for patients with ESRD because of improved patient survival and quality-of-life over dialysis [1], [2], [3] and [4]. Several groups have analyzed transplantation in highly HLA-sensitized patients recently. The risks for transplantation can be assessed using currently available standard assays. Today, the techniques that are used to detect anti-HLA antibody include cytotoxicity (CDC) with/without

anti-human globulin, ELISA, and flow cytommetry (using cells and antigen-coated beads). The development of newer, more sensitive assays has led to an increased ability to define highly sensitized patients and identify donor-specific antibody [2]. Several risk factors have been described regarding sensitization to HLA antigens including blood transfusions, pregnancy and previous organ transplantation. The degree of sensitization creates an obstacle for the accessibility and success of kidney transplantation [1]. In patients with high panel-reactive antibodies (% PRA) defined as having a % PRA > 30, transplant rates are dramatically reduced because of the additional immunologic barrier with increased rejection risk [2]. In 2003, only 6.5% of all kidney transplants that were performed in the United States were in patients with PRA > 80%, despite representing approximately 14% of the waiting list [5] and [7].