Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India.
Indian J Med Res. 2017 Apr;145(4):488-491. doi: 10.4103/ijmr.IJMR_1974_15.
BACKGROUND & OBJECTIVES: Transfusion support forms an integral part of liver transplantation programme. Advanced immunohaematology services are required to deal with complex serological problems that can complicate transfusion therapy in these patients. Here, we report on red cell alloimmunization and presence of alloimmunization in donors and patients undergoing liver transplantation in a tertiary care hospital in north India.
Records of 1433 liver transplants performed from January 2009 to March 2015 were retrieved and reviewed. Antibody screening was performed both for liver donors, and recipients and antibody identification was performed for the screen-positive patients.
Of the 1433 liver recipients, 32 (2.3%) developed antibodies. Seventeen patients had one or more alloantibodies, five had autoantibodies with an underlying alloantibody and 10 had only autoantibodies in their plasma. The overall alloimmunization rate was 1.5 per cent with 25 alloantibodies identified in 22 patients. Anti-E was the most common specificity identified.
INTERPRETATION & CONCLUSIONS: The presence of alloantibodies can complicate transfusion therapy in patients undergoing liver transplantation, who are already at a high risk of being heavily transfused owing to the nature of surgery and the haemostatic dysfunction from chronic liver disease. Therefore, screening for irregular red cell alloantibodies combined with a rational blood transfusion policy may be essential for these patients.
输血支持是肝移植项目的一个组成部分。需要先进的免疫血液学服务来处理可能使这些患者的输血治疗复杂化的复杂血清学问题。在此，我们报告了在印度北部的一家三级护理医院进行肝移植的供体和患者中红细胞同种免疫和同种免疫的存在情况。
检索并回顾了 2009 年 1 月至 2015 年 3 月期间进行的 1433 例肝移植的记录。对肝供体和受体均进行了抗体筛选，并对筛查阳性的患者进行了抗体鉴定。
在 1433 例肝受体中，有 32 例（2.3%）产生了抗体。17 例患者有一种或多种同种抗体，5 例患者有自身抗体伴潜在同种抗体，10 例患者血浆中只有自身抗体。总体同种免疫率为 1.5%，在 22 例患者中鉴定出 25 种同种抗体。抗-E 是最常见的特异性。
同种抗体的存在可能使接受肝移植的患者的输血治疗复杂化，由于手术的性质和慢性肝病引起的止血功能障碍，这些患者已经处于大量输血的高风险中。因此，对不规则红细胞同种抗体进行筛查并结合合理的输血政策，可能对这些患者至关重要。
