American Journal of Transplantation: Volume 19, Number 6, June 2019

On the Cover: Alloantibody is a known risk for allograft loss, and blood transfusion is similarly well known as a source of alloantibody. However, the role of posttransplant blood transfusion, where immunosuppression is in play, in the development of de novo allosensitization is not well established. This month we feature an article by Hassan et al (page 1720) demonstrating that when blood transfusions share HLA antigens with the kidney donor, de novo alloantibody formation is common. More importantly, when transfusion-associated alloantibody occurs, it significantly reduces graft survival. This article draws stark attention to post–kidney transplant transfusion practices and suggests that when blood transfusion is needed, shared donor antigens should be avoided or immunosuppression should be modified. Cover design by Lauren Halligan, Duke University Department of Surgery.