A STUDY OF HLA CLASS I ANTIBODIES IN TRANSFUSED PATIENTS WITH CHRONIC KIDNEY DISEASE IN LAGOS NIGERIA

Abstract

Background: Due to the high cost of erythropoietin, a large proportion of patients with
CKD/ESKD in developing countries still receive blood transfusions for the management
of anaemia of kidney disease. Blood transfusion increases the risks for the development
of HLA antibodies, the presence of these antibodies in the recipient reduces the chances
of survival of transplanted kidney.
Aim: The study aims to determine the prevalence of Human Leukocyte Antigen (HLA)
Class I antibodies in transfused patients with chronic kidney disease.
Method: It was a cross sectional study, CKD subjects with transfusion dependent
anaemia were recruited, as well as CKD patients who had not being receiving blood
transfusion. They were screened for HLA Class I antibodies using the Quik-ID® Class I
qualitative solid phase ELISA kit. Full blood count, blood grouping and serum creatinine
were also determined. Percentage panel reactive antibodies (%PRA) was determined by
expressing the number of wells that each specimen showed positive HLA antibody
result, as a percentage of the number of wells that contained HLA Class I antigens.
Results: There were 100 subjects in the study arm and 20 in the control arm, 88% of the
study group subjects were sensitized, whereas only one (5%) of the control group was
sensitized, p=0.000. Female subjects had higher %PRA (59.5%) than males (28.6%),
p=0.008. There was a positive association between the units of blood transfusions
received and the level of sensitization in the study group, r= 0.842, p=0.000.

The haematological profile of both groups was assessed. This study shows a significant
difference in all the haematological parameters measured between the study group and
controls except MCV, MCHC and platelet count.
Blood group O (54.2%) was the most common blood group amongst the participants.
Three leading risk factors for CKD observed amongst participants were: hypertension
(30.8%), diabetes mellitus (25.0%), and glomerulonephritis (20.8%). Patients with
Diabetes mellitus had higher percentage mean PRA values (75.60±15.02) when
compared with hypertension (39.39±22.90) and glomerulonephritis (22.38±18.14).
Conclusion: This study shows a high prevalence of alloimmunization to HLA Class I
antibody in transfused CKD patients, and the degree of sensitization is positively
correlated to the number of blood units transfused.