Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Res. 2020 Nov;255:99-105. doi: 10.1016/j.jss.2020.05.029. Epub 2020 Jun 16.
Patients undergoing liver transplantation (LT) frequently receive platelet transfusion (PLT) to minimize their risk of hemorrhage. Alloimmunization to platelets may lead to refractoriness to PLT. Data on the implications of platelet alloimmunization in patients undergoing LT remain limited. We examined the effect of human leukocyte antigen class I (HLA-I) antibodies on PLT refractoriness and short-term outcomes after LT.
Peritransplant clinical and PLT factors were reviewed for all adult liver or simultaneous liver-kidney transplantations from 2012 to 2017. Sensitized patients (SE) with pretransplant HLA-I calculated panel-reactive antibody ≥20% were compared with unsensitized patients (US) with calculated panel-reactive antibody <20%. The mean follow-up was 21.4 mo.
Alloimmunization was observed in 39% of the study cohort. SE (n = 28) received 272 PLTs, and US (n = 44) received 246 PLTs. History of pregnancy was higher among SE than US (P < 0.01); otherwise, both groups had similar clinical characteristics. SE had higher rates of PLT refractoriness (66% versus 47%; P < 0.01) than US. The mean platelet corrected count increment was lower among SE compared with US up to 100 min after PLT (P < 0.05). Alloimmunization and simultaneous liver-kidney transplantation independently predicted refractoriness on multivariate logistic regression (P < 0.05). Early allograft rejection and patient survival rates were comparable for both groups.
LT patients experienced high rates of HLA-I alloimmunization and PLT refractoriness. SE had higher rates of refractoriness and lower mean corrected count increment after transfusion compared with US. Our study suggests that further research to evaluate the utility of HLA-matched PLTs in HLA-I alloimmunized LT patients is warranted.
接受肝移植（LT）的患者常需输注血小板（PLT）以降低出血风险。血小板同种免疫可能导致 PLT 输注无效。有关 LT 患者血小板同种免疫影响的数据仍有限。我们研究了人类白细胞抗原 I 类（HLA-I）抗体对 LT 后 PLT 输注无效和短期结局的影响。
回顾了 2012 年至 2017 年期间所有成人肝移植或同时肝肾移植的围手术期临床和 PLT 因素。与计算出的 panel-reactive antibody<20%的未致敏患者（US）相比，我们比较了有预致敏 HLA-I 抗体（SE）的患者（n=28，计算出的 panel-reactive antibody≥20%）。平均随访时间为 21.4 个月。
研究队列中观察到 39%的患者发生同种免疫。SE（n=28）接受了 272 单位 PLT，US（n=44）接受了 246 单位 PLT。SE 组有妊娠史的比例高于 US 组（P<0.01）；其他方面，两组的临床特征相似。SE 组 PLT 输注无效发生率（66% vs 47%；P<0.01）高于 US 组。SE 组血小板校正计数增加值在输注后 100 分钟内均低于 US 组（P<0.05）。多变量逻辑回归显示，同种免疫和同时肝肾移植是输注无效的独立预测因素（P<0.05）。两组患者早期移植物排斥和患者存活率相似。
LT 患者 HLA-I 同种免疫和 PLT 输注无效发生率高。SE 组的 PLT 输注无效发生率和输血后平均校正计数增加值均高于 US 组。我们的研究表明，需要进一步研究评估 HLA 匹配的 PLT 在 HLA-I 同种免疫 LT 患者中的应用价值。
