Anti-erythrocyte antibodies, leukocytotoxins and human renal allograft survival.

ABO blood group compatibility is generally required for successful human kidney transplants and new data suggest donor-recipient incompatibility for the Lewis or multiple minor blood groups is detrimental. This is of special importance in the setting of liberal transfusions prior to transplant. To assess the impact of immunizing exposure to disparate blood groups of ABO-matched transfusions and kidney transplants, we studied the interrelationships of anti-erythrocyte antibodies, leukocytotoxins and graft survival in 42 kidney transplant recipients. Three hundred forty-four sera were screened for anti-erythrocyte antibodies using standard hemagglutination techniques and leukocytotoxins, using the antiglobulin method. Statistical analysis by computer used a 2 x 2 x 2 contingency table with model fitting. Only 13 of 42 patients had anti-erythrocyte antibodies at some time: anti-I (4); anti-Kell (1); cold panagglutinin (7); unidentifiable agglutinin (1). Of 42 patients, 16 had no detectable leukocytotoxins. By computer analysis, immunizations to blood group and HLA antigens were independent phenomena. Analysis showed that leukocytotoxins, but not anti-erythrocyte antibodies, were associated with poor graft survival. A computer generated probability of graft survival by antibody status is presented. We conclude that immunization to blood group antigens is not common, is largely non-specific, and is not detrimental to kidney graft survival.