Journal article
Allosensitization From Blood Transfusion in Pediatric Solid Organ Transplant Candidates: Impact of Irradiation
Pediatric transplantation, Vol.30(1), e70265
01/2026
DOI: 10.1111/petr.70265
PMID: 41508091
Abstract
Up to 30% of patients develop anti-HLA antibodies following a single transfusion with leukoreduced packed red blood cells (pRBCs). While some speculate that irradiation of pRBCs could reduce the risk of allosensitization, its effect in clinical practice remains unclear.
A single-center, retrospective study was conducted with 93 pediatric solid organ transplant (SOT) candidates from January 2013 to July 2022. All participants had a baseline calculated panel reactive antibody (cPRA) of 0% and underwent repeat cPRA testing at least 28 days after pRBC transfusion to evaluate for de novo allosensitization. Patients were stratified by pRBC preparation: exclusively irradiated pRBC versus any exposure non-irradiated pRBC. The primary outcome was the incidence of interval allosensitization in each group.
A total of 17 of 93 patients (18.3%) developed anti-HLA antibodies. In the non-irradiated group, allosensitization occurred in 8/39 patients (20.5%) compared to 9/54 (16.7%) in the irradiated group (χ
= 0.22, p = 0.7866). In multivariable analysis, the number of pRBC transfusions was the only risk factor to increase the odds of allosensitization (OR 1.18, p = 0.004). Number of non-pRBC sensitizing events was paradoxically found to be protective (OR 0.8, p = 0.03). Chronic immunosuppression did not mitigate allosensitization risk, although IVIG was associated with a non-significant risk reduction (OR 0.12, p = 0.07).
The number of pRBC transfusions remains the strongest modifiable risk factor for pre-transplant allosensitization in pediatric SOT candidates. Irradiation of pRBC did not significantly reduce the risk of transfusion-associated allosensitization in this population. IVIG may have a protective effect and should be further evaluated in a future, better powered study.
Details
- Title: Subtitle
- Allosensitization From Blood Transfusion in Pediatric Solid Organ Transplant Candidates: Impact of Irradiation
- Creators
- Corinne M Hite - Cincinnati Children's Hospital Medical CenterKyle A Merrill - University of Iowa Health CareClifford Chin - Cincinnati Children's Hospital Medical CenterDon Hayes Jr - Cincinnati Children's Hospital Medical CenterAlexander G Miethke - University of Cincinnati Medical CenterSamuel A Kocoshis - University of Cincinnati Medical CenterCharles D Varnell - University of Cincinnati Medical CenterStephanie Kinney - Cincinnati Children's Hospital Medical CenterTeresa Ambrosino - Cincinnati Children's Hospital Medical CenterPaul Brailey - University of Cincinnati Medical CenterDavid K Hooper - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- Pediatric transplantation, Vol.30(1), e70265
- DOI
- 10.1111/petr.70265
- PMID
- 41508091
- NLM abbreviation
- Pediatr Transplant
- ISSN
- 1399-3046
- eISSN
- 1399-3046
- Publisher
- Wley
- Language
- English
- Date published
- 01/2026
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9985121525602771
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