Within the three decades since the beginnings of the field of clinical renal transplantation there have been four phases in blood transfusion policies, swinging from liberal transfusions to avoidance of transfusions, followed by a repeat cycle of deliberate transfusions and at present turning back to abstinence again. Because of improving skills at the prevention and treatment of rejections, the beneficial effects of random transfusions in the transplant population as a whole is marginal. This comes at a time when community fears of blood-borne infections and the prospects of supporting red cell production by the use of EPO have emerged as new factors in blood banking. Observations on patients at risk for graft loss, namely those having rejection episodes, indicate that a beneficial blood transfusion effect still exists, however. Future application of deliberate HLA antigen exposure in conjunction with novel immunological manipulations may provide a more effective avenue to tolerance induction. The use of blood transfusions matched for one HLA-DR antigen with the recipient has produced major benefits in preliminary trials and represents one starting point in this direction
