(P-TS-77) Safety and utility of an approach in the management of patients with RBC alloimmunization undergoing liver transplantation

Background/Case Studies: Liver transplantation is a lifesaving procedure for patients with acute or chronic end stage liver disease. Orthotopic liver transplant (OLT) is one of the most challenging procedures given the vascular complexity, altered hemostatic physiology and high bleeding risk specially in patients with advanced liver dysfunction. Despite of advancements in surgical techniques and better intraoperative (IO) management of coagulopathy, OLT is associated with unpredictable risk of bleeding that oftentimes requires massive transfusion.
Transfusion support for patients with RBC alloimmunization can be challenging due to inadequate supply of antigen negative RBC units, time needed to optimally test and prepare antigen negative, full crossmatch units, especially if massive bleeding is expected or unexpectedly encountered.
In this study, we review the safety and utility of an approach in the management of patients with RBC alloimmunization undergoing liver transplantation.

Study

Design/Methods: With the approval of the institution IRB, we performed a retrospective medical record review of patients who underwent liver transplantation with RBC alloimmunization.
Per institution’s standard operative procedure for the transfusion services, transfusion support is managed as following:
a. Start the case with 10 units of antigen negative full crossmatched units
b. Then, the case will be supported with non-antigen screened and uncrossmatched ABO type specific units
c. Close the case with 10 units of antigen negative and full crossmatched units.
The following was reviewed: RBC usage, evidence of hemolysis, and liver transplant outcomes.

Results/Findings: From July 2021 to December 2022, 5 patients had significant red cell alloimmunization prior to transplant. The mean age of patients was 57 years, 60% were males. All patients had multiple antibodies. The most common specificity was to Rh, follow by kidd, Lewis and MNS antigens. Of those, 2 patients received antigen-unscreened and uncrossmatched units with a mean of 64.5 units transfused IO.
No evidence of hemolytic transfusion reaction was detected during or in the post-transplant period and all patients were transplanted successfully.

Conclusions: Transfusion support can be provided safely in patients with RBC alloimmunization undergoing liver transplantation. RBC alloimmunization is not a barrier for liver transplantation

Importance of research: Assess the safety of transfusion practice approach in highly allo-immunized patients undergoing liver transplantation