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Pandey P, Tiwari A, Shekhar Das S, Shastry S, Kute V, Chowdhry M, Marik A, Aggarwal G, Kumari S, Setya D, Mandal S, Ranjan S. I-JAMM-(I): A survey providing an insight into the practices of isoagglutinin titration in ABO incompatible kidney and liver transplantation. Transfus Apher Sci 2024; 63:103862. [PMID: 38135545 DOI: 10.1016/j.transci.2023.103862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND OBJECTIVES ABO-incompatible transplantations allow patients to receive timely transplants. Isoagglutinin titration to ascertain levels of incompatible antibodies in the recipient is important in determining patient selection and transplant survivability. To find out the prevalent trends in India, the largest, first of its kind survey was carried out among the transplant centers regarding their practices in isoagglutinin titration. METHODS The survey was drafted by a working group of Transfusion and Transplant Immunology specialists from six different centers. Data was obtained via the use of an online questionnaire. RESULTS Results were categorized into four categories, Hospital information, Titration methodology, Role of transfusion specialists and cut-off titers. Most centers had a well-established solid-organ transplant program with considerable number of ABO-incompatible transplantations. Most centers performed isoagglutinin titration in Transfusion Medicine department. Column Agglutination Technique (CAT) was the most common method, using EDTA blood samples and freshly-prepared in-house pooled cells. Most centers had a turn-around time of less than 12 h. While the policy for ascertaining baseline and threshold titers is well-defined in ABO-incompatible renal transplants, variations from center to center still exist for ABO-incompatible liver transplants. Most centers required a Transfusion Medicine consultation for the patients before such transplants. CONCLUSION With increasing ABO-incompatible kidney and liver transplants across the country, the role of Transfusion medicine specialists has become vital in pre-conditioning regimes enabling the viability and success of such transplants. This was a unique survey that provided a snapshot of current trends and practices of isoagglutinin titration for ABO-incompatible transplants in India.
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Affiliation(s)
- Prashant Pandey
- Department of Transfusion Medicine & Transplant Immunology, Jaypee Hospital, Sector, 128, Noida 201304, India
| | - Aseem Tiwari
- Department of Transfusion Medicine, Medanta, The Medicity, Gurugram, India
| | | | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
| | - Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine, Indaprastha Apollo Hospital, New Delhi, India
| | - Arghyadeep Marik
- Department of Transfusion Medicine & Transplant Immunology, Jaypee Hospital, Sector, 128, Noida 201304, India.
| | - Geet Aggarwal
- Department of Transfusion Medicine, Medanta, The Medicity, Gurugram, India
| | - Supriya Kumari
- Department of Transfusion Medicine & Transplant Immunology, Jaypee Hospital, Sector, 128, Noida 201304, India
| | - Divya Setya
- Department of Transfusion Medicine, Manipal Hospital, Jaipur, India
| | - Saikat Mandal
- Department of Transfusion Medicine & Transplant Immunology, Jaypee Hospital, Sector, 128, Noida 201304, India
| | - Shweta Ranjan
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Patna, India
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Varón-Vega F, Rincón A, Prada L, Tuta-Quintero E, Téllez LJ. Intentional Lung Transplantation Due to ABO Incompatibility: A Case Report. Cureus 2023; 15:e51116. [PMID: 38274919 PMCID: PMC10810090 DOI: 10.7759/cureus.51116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
We present a case of a 16-year-old adolescent female with blood group O+ who was diagnosed with cystic fibrosis (CF). The patient had to be hospitalized due to septic shock and respiratory failure, and extracorporeal membrane oxygenation and mechanical ventilation were applied. Faced with high urgency, she was promptly enlisted for a lung transplant, ultimately receiving a blood group A1 deceased donor lung through rescue allocation. Bilateral incompatible lung transplantation, with parental consent, was successfully performed. The postoperative course was favorable, marked by the administration of rabbit anti-thymocyte globulin, plasmapheresis, and immunosuppression (mycophenolate, steroids, and tacrolimus) as per the prescribed protocol. Notably, the patient experienced a smooth recovery without infectious complications or humoral rejection. This case highlights the viability of lung transplantation in cases of ABO incompatibility, particularly for patients in urgent need on the transplant waiting list.
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Affiliation(s)
- Fabio Varón-Vega
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, COL
| | - Adriana Rincón
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, COL
| | - Leidy Prada
- Pulmonology Department, Fundación Neumológica Colombiana, Bogotá, COL
| | | | - Luis J Téllez
- Thoracic Surgery, Fundación Cardio Infantil, Bogotá, COL
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Balakrishnan S, Kumar L, Daniel D, Surendran S. Anaesthetic implications and transfusion practices in ABO incompatible living donor liver transplantation: Case series. Indian J Anaesth 2021; 65:331-335. [PMID: 34103749 PMCID: PMC8174586 DOI: 10.4103/ija.ija_1295_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/27/2020] [Accepted: 02/09/2021] [Indexed: 11/04/2022] Open
Abstract
ABO incompatible liver transplants (ABOi LT) are considered as a life-saving option when compatible donor grafts are unavailable. Fourteen adults (right lobe graft) and three children (left lateral segment/lobe) who underwent ABOi LT from living donors between 2011 and 20 period were analysed for transfusions and desensitisation protocols. All recipients received packed red blood cells (PRBC) of their own group. AB plasma that does not contain any antibody was transfused in eight patients and donor group plasma in others. None of the patients developed transfusion related complications. Plasmapheresis and rituximab/bortezumab desensitisation was practised in 11 patients, only rituximab in four, only plasmapheresis in one, and no treatment in a 1 year child. Rejection was manifest in three patients while nine patients developed infections and sepsis. A working knowledge of the blood and product transfusions in ABOi LT is crucial for the anaesthesiologist. Perioperative management and impact of desensitisation protocol are discussed.
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Affiliation(s)
- Sindhu Balakrishnan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vidya Vishwapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vidya Vishwapeetham, Kochi, Kerala, India
| | - Divya Daniel
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vidya Vishwapeetham, Kochi, Kerala, India
| | - Sudhindran Surendran
- Department of Gastrosurgery and Solid Organ Transplant, Amrita Institute of Medical Sciences, Amrita Vidya Vishwapeetham, Kochi, Kerala, India
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Zhang T, Barrett S, Cotton R, Galvan NTN, O'Mahony C, Moore Vierling J, Goss JA, Rana A. Pediatric length-of-stay index following liver transplantation. Pediatr Transplant 2020; 24:e13779. [PMID: 32720748 DOI: 10.1111/petr.13779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND PELD scores are used to reduce waitlist mortality, but they do not accurately predict likelihood of prolonged length-of-stay or higher costs associated with it. This study aims to create a pediatric length-of-stay (LOS) index to predict increased risk of prolonged stay following liver transplantation. METHODS The scoring system generated predicts length-of-stay following pediatric liver transplantation. With univariate and multivariate analyses on data from 5669 pediatric liver transplant recipients, independent recipient/donor risk factors for prolonged stay (>30 days) were identified. Multiple imputations accounted for missing variables. RESULTS The most significant factors were ICU admission (OR 2.92, CI 2.27-3.75), recipient bilirubin >32 (OR 2.35, CI 1.70-3.25), and hemodialysis 1 week before transplantation (OR 2.27, CI 1.57-3.27). The LOS index assigns weighted scoring points to factors to predict prolonged stay (C-statistic of .72). The index demonstrated discrimination across the population after dividing it into quartiles for prolonged stay. CONCLUSIONS The pediatric LOS index, utilizing 13 donor/recipient factors, can assess the risk for pediatric liver transplantation prolonged stay. Important predictive factors are hemodialysis, ICU admission, recipient weight and bilirubin, and recipient life support status.
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Affiliation(s)
- Theodore Zhang
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | - Spencer Barrett
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | - Ronald Cotton
- Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Christine O'Mahony
- Division of Abdominal Transplantation, Liver Center, Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - John Moore Vierling
- Division of Gastroenterology, Nutrition & Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - John A Goss
- Division of Abdominal Transplantation, Liver Center, Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
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Comment on "Lessons learnt from living donor liver transplantation with ABO-incompatibility: A single-center experience from southern India". Indian J Gastroenterol 2019; 38:276-277. [PMID: 31230263 DOI: 10.1007/s12664-019-00967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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