Uzuni Ajna, El-Bashir Jaber, Galusca Dragos, Yeddula Sirisha, Nagai Shunji, Yoshida Atsushi, Abouljoud Marwan S, Otrock Zaher K
Department of Pathology, Wayne State University School of Medicine, Transfusion Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Vox Sang. 2022 Mar;117(3):408-414. doi: 10.1111/vox.13190. Epub 2021 Aug 13.
Orthotopic liver transplantation (OLT) has been associated with high blood transfusion requirements. We evaluated the transfusion needs and frequency of alloimmunization to RBC antigens among OLT recipients pre- and post-transplantation.
We reviewed the medical records of patients who underwent a first OLT between January 2007 and June 2017. Transfusions given only during the perioperative period, defined by 1 week before OLT until 2 weeks following OLT, were included in this study. Records were reviewed in June 2019 for updated antibody testing results.
A total of 970 patients underwent OLT during the study period. The median age of patients was 57 years; 608(62.7%) were male. During the perioperative period, transfused patients received an average of 10.7 (±10.7) RBC units, 15.6 (±16.2) thawed plasma units and 4.1 (±4.3) platelet units. At the time of OLT, a total of 101 clinically significant RBC alloantibodies were documented in 58(5.98%) patients. Fifty-three of these antibodies were directed against Rh blood group antigens. Twenty-two (37.9%) patients had more than one alloantibody. Patients with alloimmunization before OLT (N = 58) received perioperatively comparable number of RBCs to non-alloimmunized patients (10.5 ± 10.6 vs. 9.6 ± 10.7; p = 0.52). There was no significant difference in perioperative or intraoperative RBC transfusion between patients with one alloantibody and those with multiple alloantibodies. Only 16 patients (16/737; 2.17%) developed new alloantibodies at a median of 61 days after OLT. The overall alloimmunization rate was 9.8% (72/737), and female patients were more likely to be alloimmunized.
Blood transfusion requirements in OLT remain high. However, the rate of RBC alloimmunization was not higher than the general patient population.
原位肝移植（OLT）往往需要大量输血。我们评估了OLT受者移植前后对红细胞抗原的输血需求及同种免疫频率。
我们回顾了2007年1月至2017年6月期间接受首次OLT的患者的病历。本研究纳入仅在围手术期（定义为OLT前1周直至OLT后2周）进行的输血。2019年6月对病历进行回顾以获取最新的抗体检测结果。
研究期间共有970例患者接受了OLT。患者的中位年龄为57岁；608例（62.7%）为男性。在围手术期，接受输血的患者平均输注了10.7（±10.7）个红细胞单位、15.6（±16.2）个解冻血浆单位和4.1（±4.3）个血小板单位。在OLT时，共有58例（5.98%）患者记录到101种具有临床意义的红细胞同种抗体。其中53种抗体针对Rh血型抗原。22例（37.9%）患者有不止一种同种抗体。OLT前发生同种免疫的患者（N = 58）围手术期接受的红细胞数量与未发生同种免疫的患者相当（10.5±10.6对9.6±10.7；p = 0.52）。具有一种同种抗体的患者与具有多种同种抗体的患者在围手术期或术中的红细胞输血方面无显著差异。仅16例患者（16/737；2.17%）在OLT后中位61天出现新的同种抗体。总体同种免疫率为9.8%（72/737），女性患者更易发生同种免疫。
OLT的输血需求仍然很高。然而，红细胞同种免疫率并不高于普通患者群体。
