UMass Memorial Medical Center Worcester, Massachusetts, United States
Background/Case Studies: Despite a significant decrease of blood use in liver transplantation over the past decade, orthotopic liver transplants (OLT) may still require large numbers of blood components perioperatively. As the inventory of D-negative (D-) RBCs is limited in many institutions, some D- liver transplant patients may need to be transfused with D-positive (D+) RBCs perioperatively. It is generally believed that the incidence of anti-D alloimmunization varies with the volume of transfused D+ RBCs and the recipient’s immunocompetence. This study aimed to investigate the rate of anti-D formation in D- liver transplant patients who received D+ RBCs perioperatively.
Study
Design/Methods: In this single-center retrospective study, electronic medical records and blood bank files of 521 cases of OLT performed at our hospital from January 2015 to February 2023 were reviewed to identify the D- patients who received D+ RBCs perioperatively. Demographic details, clinical history, perioperative RBC transfusion and follow-up (F/u) antibody screening data were collected for each patient. All patients were treated with immunosuppressants after transplant as per protocol, and none of them received Rh immunoglobulin prophylaxis.
Results/Findings: Of 19 D- patients who received D+ RBCs perioperatively, two were excluded due to lack of follow-up antibody screening. Of the remaining 17 patients, 15 received ABO identical and D+ organs, and two received ABO identical and D- organs. Patient characteristics are listed in Table 1. The median age was 59 years (range 33-71 years), and nine were male (53%). The median of D+ RBC unit exposure was 7 units (range 1 – 46 units) and the mean follow-up time was 5 weeks (range 2 – 208 weeks). None of these patients developed an anti-D antibody after a median of 5 weeks of serologic follow-up. Conclusions: Our findings are consistent with the previous reports that the rate of anti-D alloimmunization is very low in liver transplant patients. It appears to be safe and acceptable to transfuse D+ RBCs in D- OLT recipients perioperatively. This practice allows for the conservation of D- RBCs, permitting use of this scare resource where it is more likely to provide benefits to patients.
Importance of research: This study aimed to investigate the rate of anti-D formation in D- liver transplant patients who received D+ RBCs perioperatively. Our findings are consistent with the previous reports that the rate of anti-D alloimmunization is very low in liver transplant patients. It appears to be safe and acceptable to transfuse D+ RBCs in D- OLT recipients perioperatively. This practice allows for the conservation of D- RBCs, optimizing use of this scare resource.
