Prospective evaluation of immune haemolysis in liver transplantation

Abstract

Background Immune haemolysis in liver transplant (LT) can occur due to autoantibodies and alloantibodies. The aim of this study was to evaluate the prevalence and risk factors for immune haemolysis in LT.Methods A total of 175 consecutive patients were included. Multiorgan recipients were excluded. Samples, from before LT, seven consecutive days and weekly for 4 weeks, were evaluated for haemolysis and immunohaematological tests. SPSS 24 was used for statistical analysis.Results Nine patients (5Á1%) presented positive antibody screen (AS) before LT, (2Á3% clinically significant), more frequent in RhD-negative (P = 0Á017). Positive DAT occurred in 53 (30Á3%) and was related to high MELD score (P = 0Á048), HCV (P = 0Á005) and furosemide use (P = 0Á001). Positive AS after LT occurred in 22 patients (12Á5%), with nine (5Á7%) clinically significant antibodies. Positive AS occurred more frequently in RhD negative (P = 0Á021) and in those transfused (P = 0Á022). Post-transplant positive DAT was associated with piperacillintazobactam use (P = 0Á021) and minor ABO incompatibility (P = 0Á0038). Five patients presented passenger lymphocyte syndrome (PLS), all received liver-graft O, four presented haemolysis, and three were transfused due to PLS.Conclusion Auto-and alloantibodies against red blood cell antigens are frequent in LT, but the frequency of immune haemolysis was only 2Á8%. The only risk factor for PLS was minor ABO mismatch.

Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation

“…The incidence of biochemically evident passenger lymphocyte syndrome in liver transplantation is reported to be up to 40%; however, less than 30% of these cases will demonstrate clinically significant haemolysis requiring intervention 7–9. Less than 20 published studies have reported passenger lymphocyte syndrome following liver transplantation 4 5 8 10–26. Most cases were in the setting of minor ABO mismatch followed by Rh incompatibility.…”

Síndrome del linfocito pasajero por anticuerpos anti-D en trasplante hepático. Reporte de caso

“…Generalmente la presentación es leve y autolimitada con remisión espontánea, aunque en ocasiones la presentación puede ser grave (16) . En otros casos puede ser subclínica y encontrarse como hallazgo incidental en los laboratorios de seguimiento o sobreponerse a complicaciones perioperatorias.…”