In patients with organ failure, immunological challenges with ABO and HLA remain a major hurdle to transplantation. Transfusions can down-regulate immune responsiveness, leading to improved outcomes in renal transplantation, even with modern immunosuppression. In contrast, patients who have had previous pregnancies, transplants or a high number of transfusions may have broad HLA sensitization that can preclude transplantation or increase the risk of organ rejection.

This audioconference will discuss causes and mechanisms of allosensitization in relation to blood transfusion. The program will also detail apheresis practices involved in densensitizing patients to render them ready to accept an "incompatible" organ and to treat allograft rejection. The presentation will introduce anticipated future trends such as apheresis in supplementing newer pharmacological interventions, erythropoiesis stimulating agents, autologous blood and HLA matched blood. To be effective, these strategies need to be part of a concerted effort of clinicians, surgeons and blood bankers.