What are the best practices for preparing blood for transfusion in a patient with a kidney transplant to minimize complications?

HLA sensitization via blood transfusions could present problems with transplant candidates (diminishing the chance of finding a compatible donor) and for transplant recipients (greater hazards for deceased censored graft loss, Massicotte-Azarnioch et al., PMID 33912754). Scornik & Meier-Kriesche, PMID 21883910 outlined the risk of blood transfusions and its impact on inducing HLA sensitization among naive kidney transplant candidates. Multiple transfusions, prior pregnancies, and previous transp...

Leukoreduced will minimize the risk of HLA sensitization. I believe states regulate whether all units of blood are leukoreduced or not. Using leukofilters, I believe, is the primary method for reducing leukocytes. There are other methods of leukocyte reduction, such as removing the buffy coat or washing the RBCs, though I do not believe these are routinely used. Best practice is to discuss with the local blood bank about the options available.

The use of leukoreduced blood to decrease the risk of allo-sensitization against HLA that can increase the risk of developing DSA against the allograft despite the use of immunosuppression post transplantation. Very rarely we recommend the use of irradiated blood to prevent transfusion-induced Graft versus host disease due to engraftment of blood donor viable T cells in a kidney transplant recipient. We recommend limiting blood transfusions before transplant to decrease the risk for allo-sensiti...