Red Blood Cell Antigen Alloimmunization in Liver Transplant Recipients

Luzo, Ângela Cristina Malheiros; Pereira, Fabrício Ramos Silvestre; Oliveira, Regina Célia de; Azevedo, Patricia; Cunha, Rafael da; Leonardi, M.I.; Leonardi, Luiz Sérgio; Cardoso, Alisson C.; Caruy, C.A.; Ataide, E. C.; Boin, I.F.S.F.

doi:10.1016/j.transproceed.2010.01.010

Cited by 15 publications

(19 citation statements)

References 3 publications

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“…This is in keeping with studies on other multitransfused patients in India which have repeatedly shown a lower rate of alloimmunization as compared to studies from other regions of the world which have reported alloimmunization rates ranging from 9.4% to 23%. [461011] Rate of alloimmunization in multitransfused ranges from 3% to 10% in most reports from India. [121314] Lower rates of alloimmunization may be explained by supposedly high prevalence of phenotypic similarity between blood donors and transfusion recipients in the Indian population.…”

Section: Discussionmentioning

confidence: 99%

“…This is similar to the previous reports of alloimmunization. [62324] As is evident from these findings, antibodies against the Rh and Kell system are the most commonly implicated alloantibodies. This re-iterates the need for extended Rh and Kell phenotype-matched RBCs in patients requiring repeated transfusions to prevent RBC alloimmunization.…”

Section: Discussionmentioning

confidence: 99%

“…[123] The requirement of multiple transfusions in liver disease patients leads to a higher incidence (6–14%) of RBC alloantibody formation, adding to the difficulties in providing compatible RBCs in large quantities. [6] The impact of underlying disease on alloimmunization has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Bajpai¹,

Gupta²,

Jain³

2016

Asian J Transfus Sci

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Introduction:Transfusion support is vital to the management of patients with liver diseases. Repeated transfusions are associated with many risks such as transfusion-transmitted infection, transfusion immunomodulation, and alloimmunization.Materials and Methods:A retrospective data analysis of antibody screening and identification was done from February 2012 to February 2014 to determine the frequency and specificity of irregular red-cell antibodies in multitransfused liver disease patients. The clinical and transfusion records were reviewed. The data was compiled, statistically analyzed, and reviewed.Results:A total of 842 patients were included in our study. Alloantibodies were detected in 5.22% of the patients. Higher rates of alloimmunization were seen in patients with autoimmune hepatitis, cryptogenic liver disease, liver damage due to drugs/toxins, and liver cancer patients. Patients with alcoholic liver disease had a lower rate of alloimmunization. The alloimmunization was 12.7% (23/181) in females and 3.17% (21/661) in males. Antibodies against the Rh system were the most frequent with 27 of 44 alloantibodies (61.36%). The most common alloantibody identified was anti-E (11/44 cases, 25%), followed by anti-C (6/44 cases, 13.63%).Conclusion:Our findings suggest that alloimmunization rate is affected by underlying disease. Provision of Rh and Kell phenotype-matched blood can significantly reduce alloimmunization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Bajpai¹,

Gupta²,

Jain³

2016

Asian J Transfus Sci

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“…Immunosuppressive drugs reduce the risk of alloimmunization . By contrast, patients with chronic liver disease are known to have a high incidence of RBC alloantibody formation before LT, ranging from 6 to 23% …”

Section: Discussionmentioning

confidence: 99%

Predisposing factors for anti‐D immune response in D⁻ patients with chronic liver disease transfused with D⁺ platelet concentrates

et al. 2019

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BACKGROUND Recent reports have indicated that the risk of anti‐D alloimmunization following D‐incompatible platelet (PLT) transfusion is low in hematology and oncology patients. We investigated the rate of anti‐D alloimmunization in RhD‐negative (D−) patients with chronic liver disease transfused with D+ platelet concentrates (PCs) and the factors involved, at a liver transplant (LT) center. STUDY DESIGN AND METHODS We reviewed the blood bank database from January 2003 to October 2016. D− patients who had received D+ PLT transfusions were eligible if they had undergone antibody screening at least 28 days after the first D+ PC transfusion, had no previous or concomitant exposure to D+ blood products, and had not received anti‐D immunoglobulins. RESULTS Six of the 56 eligible patients (10.7%) had anti‐D antibodies. All had received whole blood‐derived PCs. Four of 20 patients (20%) untransplanted or transfused before LT and only two of 36 patients (5.6%) transfused during or after LT produced anti‐D antibodies. These two patients were on maintenance immunosuppression based on low‐dose steroids and tacrolimus. The factors identified as significantly associated with anti‐D immune response were the presence of red blood cell immune alloantibodies before D+ PLT transfusion (p = 0.003), and D+ PLT transfusion outside the operative and postoperative (5 days) periods for LT (p = 0.023). CONCLUSION D− patients with chronic liver disease transfused with D+ PLTs before LT are at high risk of developing anti‐D antibodies. Preventive measures should be considered for these patients.

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“…Luzo et al reported 23% incidence of red cell alloantibodies among liver transplantation patients in their center [6]. Ramsey et al reported that out of 1000 liver transplantations performed in their center, 13.7% of adults and 6.3% of children had significant RBC alloantibodies [2].…”

Section: Discussionmentioning

confidence: 99%

Alloantibodies and Drug-Induced Immune Hemolytic Anemia in Liver Transplantation

Allanki

2011

Case Reports in Transplantation

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Red blood cell alloantibodies can cause severe delayed hemolysis, despite immunosuppression which they receive posttransplantation. A female patient with Hepatitis C-related chronic liver disease reported to our center for liver transplantation. During preoperative evaluation, she was found to have significant red blood cell alloantibodies which gave rise to problems during pre transfusion compatibility test. Stringent measures were taken by the transplant team to minimize blood loss during surgery. It was decided to have lower transfusion trigger for red cell transfusion, and blood conservation was done by intraoperative red cell salvage and use of antifibrinolytic agent. During immediate postoperative period, she developed drug-related immune hemolytic anemia. Presence of both warm autoantibodies and alloantibodies posed a big challenge for us to get cross-match compatible blood. She received 22 units of crossmatch compatible red cell transfusions during her hospital stay, which was uneventful. Hence, we reported this case.

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Red Blood Cell Antigen Alloimmunization in Liver Transplant Recipients

Cited by 15 publications

References 3 publications

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Predisposing factors for anti‐D immune response in D⁻ patients with chronic liver disease transfused with D⁺ platelet concentrates

Alloantibodies and Drug-Induced Immune Hemolytic Anemia in Liver Transplantation

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Red Blood Cell Antigen Alloimmunization in Liver Transplant Recipients

Cited by 15 publications

References 3 publications

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Predisposing factors for anti‐D immune response in D− patients with chronic liver disease transfused with D+ platelet concentrates

Alloantibodies and Drug-Induced Immune Hemolytic Anemia in Liver Transplantation

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Predisposing factors for anti‐D immune response in D⁻ patients with chronic liver disease transfused with D⁺ platelet concentrates