Association between renal failure and red blood cell alloimmunization among newly transfused patients

Josine A. Oud, Dorothea Evers, Rutger A. Middelburg, Karen M.K. de Vooght, Daan van de Kerkhof, Otto Visser, Nathalie C.V. Péquériaux, Francisca Hudig, Johanna G. van der Bom, Jaap Jan Zwaginga (Corresponding author)

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Background: Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion. Study Design and Methods: We performed a nationwide multicenter case-control study within a source population of newly transfused patients between 2005 and 2015. Using conditional multivariate logistic regression, we compared first-time transfusion-induced RBC alloantibody formers (N = 505) with two nonalloimmunized recipients with similar transfusion burden (N = 1010). Results: Renal failure was observed in 17% of the control and 13% of the case patients. A total of 41% of the control patients and 34% of case patients underwent acute RRT. Renal failure without RRT was associated with lower alloimmunization risks after blood transfusion (moderate renal failure: adjusted relative rate [RR], 0.82 [95% confidence interval (CI), 0.67-1.01]); severe renal failure, adjusted RR, 0.76 [95% CI, 0.55-1.05]). With severe renal failure patients mainly receiving RRT, the lowest alloimmunization risk was found in particularly these patients [adjusted RR 0.48 (95% CI 0.39-0.58)]. This was similar for patients receiving RRT for acute or chronic renal failure (adjusted RR, 0.59 [95% CI, 0.46-0.75]); and adjusted RR, 0.62 [95% CI 0.45-0.88], respectively). Conclusion: These findings are indicative of a weakened humoral response in acute as well as chronic renal failure, which appeared to be most pronounced when treated with RRT. Future research should focus on how renal failure and RRT mechanistically modulate RBC alloimmunization.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
Issue number1
Publication statusPublished - Jan 2021

Bibliographical note

Funding Information:
The authors thank Saurabh Zalpuri for his major contribution in the design of the R-FACT study. They also thank Karen van Brussel-de Groot (LUMC, Leiden), Andr? Ringeling (UMC Utrecht, Utrecht), Ruud van Woensel (Catharina Hospital, Eindhoven), Leo van den Boogaard (Catharina Hospital, Eindhoven), Mai Lie Tjoa (VUMC, Amsterdam), Nel Som (VUMC, Amsterdam), Ton Wolfhagen (Jeroen Bosch Hospital, 's-Hertogenbosch), Eugenie Gemen (Jeroen Bosch Hospital, 's-Hertogenbosch), and Gerard Smouter (LabWest/Haga Teaching Hospital, The Hague) for their support regarding the data collection.

Publisher Copyright:
© 2020 The Authors. Transfusion published by Wiley Periodicals LLC. on behalf of AABB.

Copyright 2021 Elsevier B.V., All rights reserved.


  • blood transfusion
  • dialysis
  • red blood cell alloimmunization
  • renal failure
  • renal replacement therapy


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