P values <0.05 were shown in bold. a Significant factors on univariable analysis were included. BMI, body mass index; CI, confidence interval; DCD, donation after circulatory death; FFP, fresh frozen plasma; MELD, model for end-stage liver disease; OR, odds ratio; PRBC, packed red blood cells.

Background and Objectives Orthotopic liver transplantation (OLT) has been associated with high blood transfusion requirements. We evaluated the transfusion needs and frequency of alloimmunization to RBC antigens among OLT recipients pre‐ and post‐transplantation. Materials and Methods We reviewed the medical records of patients who underwent a first OLT between January 2007 and June 2017. Transfusions given only during the perioperative period, defined by 1 week before OLT until 2 weeks following OLT, were included in this study. Records were reviewed in June 2019 for updated antibody testing results. Results A total of 970 patients underwent OLT during the study period. The median age of patients was 57 years; 608(62.7%) were male. During the perioperative period, transfused patients received an average of 10.7 (±10.7) RBC units, 15.6 (±16.2) thawed plasma units and 4.1 (±4.3) platelet units. At the time of OLT, a total of 101 clinically significant RBC alloantibodies were documented in 58(5.98%) patients. Fifty‐three of these antibodies were directed against Rh blood group antigens. Twenty‐two (37.9%) patients had more than one alloantibody. Patients with alloimmunization before OLT (N = 58) received perioperatively comparable number of RBCs to non‐alloimmunized patients (10.5 ± 10.6 vs. 9.6 ± 10.7; p = 0.52). There was no significant difference in perioperative or intraoperative RBC transfusion between patients with one alloantibody and those with multiple alloantibodies. Only 16 patients (16/737; 2.17%) developed new alloantibodies at a median of 61 days after OLT. The overall alloimmunization rate was 9.8% (72/737), and female patients were more likely to be alloimmunized. Conclusion Blood transfusion requirements in OLT remain high. However, the rate of RBC alloimmunization was not higher than the general patient population.

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Background and Objectives D‐negative patients undergoing orthotopic liver transplantation (OLT) might require a large number of red blood cell (RBC) units, which can impact the inventory of D‐negative blood. The blood bank might need to supply these patients with D‐positive RBCs because of inventory constraints. This study evaluates the prevalence of anti‐D formation in D‐negative OLT patients who received D‐positive RBCs perioperatively, as this will assist in successful patient blood management. Materials and Methods This was a retrospective study performed at a single academic medical centre. Electronic medical records for all 1052 consecutive patients who underwent OLT from January 2007 through December 2017 were reviewed. D‐negative patients who were transfused perioperatively with D‐positive RBCs and had antibody screening at least 30 days after transfusion were included. Results Of a total of 155 D‐negative patients, 23 (14.8%) received D‐positive RBCs perioperatively. Seventeen patients were included in the study. The median age was 54 years (range 36–67 years); 13 (76.5%) were male. The median number of D‐positive RBC units transfused perioperatively was 7 (range 1–66 units). There was no evidence of D alloimmunization in any patient after a median serologic follow‐up of 49.5 months (range 31 days to 127.7 months). The average number of antibody screening post OLT was 7.29. Conclusion Our study showed that transfusion of D‐positive RBCs in D‐negative OLT recipients is a safe and acceptable practice in the setting of immunosuppression. This practice allows the conservation of D‐negative RBC inventory.

Objective(s): Our hypothesis was that our devised transesophageal echocardiography probe cover with the capacity for pinpoint suction would improve image quality.