Feature Articles Do Perioperative Blood Transfusions Increase the Risk of Cancer Recurrence

PREVIOUS EXIWSURE to histocompatibility antigens by allogeneic blood transfusion can sensitise a potential organ recipient and result in “hyperacute” rejection of a subsequent organ graft. It therefore came as a surprise in 1973 when Opelz et al. [l] reported that previous blood transfusions were associated with improved graft survival in recipients of cadaver kidney transplants. This observation was confirmed by others, some of whom demonstrated that graft survival was even better if the recipient had been transfused with blood from the renal donor [2]. Although it was initially argued that improved graft survival after blood transfusion resulted from the selection of donors against whom the recipient is immunologically unresponsive, subsequent data suggest that the mechanisms involved are more complex and involve active suppression of both specific and non-specific responses to the transplanted organ. Interestingly, these important observations of the 1970s and early 1980s are no longer as relevant for renal transplantation, since better donor-recipient matching and the use of cyclosporin posttransplantation have substantially reduced the likelihood of graft rejection.