Transfusion requirements and alloimmunization to red blood cell antigens in orthotopic liver transplantation

Abstract

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.

Lack of alloimmunization to the D antigen in D‐negative orthotopic liver transplant recipients receiving D‐positive red blood cells perioperatively

“…OLT has developed throughout the years and become the standard of care for advanced liver disease. Although the use of blood components during OLT has considerably decreased over the past two decades, transfusion demands are still significant, especially during the perioperative period [2]. There is also wide variation in transfusion rates between transplantation centres, which can be attributed to specific patient population, surgical techniques, differences in institutional transfusion practices, variable use of antifibrinolytics and intraoperative blood salvage, among other variables [11].…”

“…In this study, we reviewed the medical records of OLT patients to during the perioperative period [2]. There is also wide variation in transfusion rates between transplantation centres, which can be attributed to specific patient population, surgical techniques, differences in institutional transfusion practices, variable use of antifibrinolytics and intraoperative blood salvage, among other variables [11].…”

“…The detailed immunosuppression protocol has been described previously [2]. Briefly, induction immunosuppression included rabbit anti‐thymocyte globulin or basiliximab.…”

“…Advances in surgical techniques and anaesthetic management have contributed to an overall reduction in the transfusion needs during and following liver transplantation. Despite blood management, liver transplantation is still associated with high blood transfusion requirements perioperatively because of abnormal haemostasis and bleeding complications [2,3]. D-negative patients are routinely transfused with D-negative red blood cells (RBCs) because of the high immunogenicity of the D antigen.…”

A case for a national registry of red blood cell antibodies

“…Studies have found that 4%–23% of liver transplant patients can have red cell alloantibodies pre‐transplant [3]. Unfortunately, most hospitals do not have access to even a local or regional registry of RBC antibodies to look up patients' previous history.…”