1
|
Mathavan A, Krekora U, Kleehammer AC, Mathavan A. Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation. BMJ Case Rep 2024; 17:e259259. [PMID: 38453222 PMCID: PMC10921429 DOI: 10.1136/bcr-2023-259259] [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] [Indexed: 03/09/2024] Open
Abstract
Passenger lymphocyte syndrome is an immunologic disorder observed in solid organ and haematopoietic stem cell transplantation in which B lymphocytes within a donor graft are transferred to the recipient and subsequently produce circulating antibodies against host red blood cell antigens. The syndrome is most likely to occur in minor ABO blood group mismatched or Rh incompatible transplantation. Although generally mild and self-limited, the resulting haemolytic burden has the potential to increase the risk of infection, graft failure and death. The phenomenon is observed in the transplantation of any solid organ with lymphoid tissue, including the liver. We present a structured case report of passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation, which was initially complicated by blood loss anaemia early in the postoperative period. By reviewing the limited literature of this disorder following liver transplantation, we emphasise common clinical findings and treatment strategies as well as introduce chimerism analysis to confirm resolution.
Collapse
Affiliation(s)
- Akash Mathavan
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Urszula Krekora
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | | | - Akshay Mathavan
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Seong H, Jang Y, Ko E, Lee J, Kim T, Lim CH, Shin HJ, Kim YH, Kim DS. Impact of preoperative red blood cell transfusion on long-term mortality of liver transplantation: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34914. [PMID: 37713857 PMCID: PMC10508566 DOI: 10.1097/md.0000000000034914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 09/17/2023] Open
Abstract
Preoperative red blood cell (RBC) transfusion can induce immune modulation and alloimmunization; however, few studies have investigated the effect of preoperative transfusion and hemoglobin levels that need to be corrected before surgery, especially in critically ill patients such as those with end-stage liver disease who undergo liver transplantation (LT). This study aimed to investigate the effects of preoperative RBC transfusion on long-term mortality in LT recipients. A total of 249 patients who underwent LT at a single center between January 2012 and December 2021 were included in this study. The patients were divided into 2 groups: preoperative transfusion and preoperative non-transfusion. Since the baseline characteristics were significantly different between the 2 groups, we performed propensity score matching, including factors such as the Model for End-Stage Liver Disease score and intraoperative RBC transfusion, to exclude possible biases that could affect prognosis. We analyzed the 5-year mortality rate as the primary outcome. The preoperative transfusion group showed a 4.84-fold higher hazard ratio than that in the preoperative non-transfusion group. There were no differences in 30-day mortality, duration of intensive care unit stay, or graft rejection rate between the 2 groups. Preoperative transfusion could influence long-term mortality in LT, and clinicians should pay attention to RBC transfusion before LT unless the patient is hemodynamically unstable. A large-scale randomized controlled trial is needed to determine the possible mechanisms related to preoperative RBC transfusion, long-term mortality, and the level of anemia that should be corrected before surgery.
Collapse
Affiliation(s)
- Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yookyung Jang
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eunji Ko
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jaehee Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Taesan Kim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Changwon Hanmaeum Hospital, Changwon, South Korea
| | - Dong-Sik Kim
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
Chornenkyy Y, Gama AP, Felicelli C, Khurram N, Booth AL, Leventhal JR, Ramsey GE, Yang GY. Alloimmunization Against RBC Antigens Is Not Associated With Decreased Survival in Liver Transplant Recipients. Am J Clin Pathol 2023; 159:255-262. [PMID: 36626677 DOI: 10.1093/ajcp/aqac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Improvement of liver transplantation (LT) outcomes requires better understanding of factors affecting survival. The presence of RBC alloantibodies (RBCAs) on survival in LT recipients was evaluated. METHODS This study was a single-center, retrospective cohort study reviewing transfusion records and all-cause mortality between 2002 and 2021. RESULTS Between 2002 and 2021, 2079 LTs were completed, 1,396 of which met inclusion criteria (1,305 RBCA negative; 91 RBCA positive [6.5%]). The cohorts were similar in age (mean [range], 55.8 [17-79] years vs 56.8 [25-73] years; P = .41, respectively) or sex (RBCA negative, 859 [65%] men and 446 [35%] women vs RBCA positive, 51 [56%] men and 40 [44%] women; P = .0684). Of 132 RBCAs detected, 10 were most common were to E (27.27%), Jka (15.91%), K (9.09%), C (8.33%), M (6.06%), D (5.3%), Fya (4.55%), e (2.27%), c (2.27%), and Jkb (2.27%). Twenty-seven patients (29.7%) had more than 1 RBCA; the most common combinations were C with Jka (7.4%) and E with Dia (7.4%). All-cause mortality was increased in men (men, 14.45 years vs women, 17.27 years; P = .0266) and patients 65 years of age and older (≥65 years of age, 10.21 years vs <64 years of age, 17.22 years; P < .0001). The presence of RBCA (≥1) did not affect all-cause mortality (RBCA negative, 14.17 years vs RBCA positive, 15.29 years; P = .4367). The top 5 causes of death were infection (11.9%), primary malignancy (solid) (10.8%), recurrent malignancy (10.5%), cardiovascular arrest (7.1%), and pulmonary insufficiency/respiratory failure (5.7%). CONCLUSIONS Survival in RBCA-positive LT recipients is no different from that in RBCA-negative LT recipients.
Collapse
Affiliation(s)
- Yevgen Chornenkyy
- Department of Pathology, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alcino Pires Gama
- Department of Pathology, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher Felicelli
- Department of Pathology, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Nigar Khurram
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam L Booth
- Department of Pathology, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph R Leventhal
- Department of Surgery, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Comprehensive Transplant Center, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Guang-Yu Yang
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Uzuni A, El-Bashir J, Galusca D, Yeddula S, Nagai S, Yoshida A, Abouljoud MS, Otrock ZK. Transfusion requirements and alloimmunization to red blood cell antigens in orthotopic liver transplantation. Vox Sang 2021; 117:408-414. [PMID: 34387366 DOI: 10.1111/vox.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/09/2021] [Accepted: 07/23/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES 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. MATERIALS AND METHODS 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. 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. CONCLUSION Blood transfusion requirements in OLT remain high. However, the rate of RBC alloimmunization was not higher than the general patient population.
Collapse
Affiliation(s)
- Ajna Uzuni
- Department of Pathology, Wayne State University School of Medicine, Transfusion Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jaber El-Bashir
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Dragos Galusca
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sirisha Yeddula
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Shunji Nagai
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Atsushi Yoshida
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Marwan S Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Zaher K Otrock
- Department of Pathology, Wayne State University School of Medicine, Transfusion Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
5
|
Brunetta DM, Barros Carlos LM, Da Silva VFP, Oliveira Alves TM, Macedo ÊS, Coelho GR, Vasconcelos JBM, De Francesco Daher E, Garcia JHP. Prospective evaluation of immune haemolysis in liver transplantation. Vox Sang 2019; 115:72-80. [DOI: 10.1111/vox.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Denise Menezes Brunetta
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Centro de Hematologia e Hemoterapia do Ceara Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
| | | | | | | | - Ênio Simas Macedo
- Department of Internal Medicine Universidade Federal do Ceara Fortaleza Brazil
| | - Gustavo Rego Coelho
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
| | | | - Elizabeth De Francesco Daher
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Internal Medicine Universidade Federal do Ceara Fortaleza Brazil
| | - José Huygens Parente Garcia
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
| |
Collapse
|
6
|
Ferre-Aracil C, Lledó JL, Aguilera L, Garcia-Paredes A, Rodríguez-Santiago E, Graus J, García-González M, Nuño J, López-Buenadicha A, López-Hervás P, Rodríguez-Gandía M, Gea F, Albillos A. Current allocation policy is favorable for patients with hepatocellular carcinoma waiting for liver transplantation. Dig Liver Dis 2018; 50:1345-1350. [PMID: 29807872 DOI: 10.1016/j.dld.2018.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL. AIMS To assess whether patients with HCC were more prioritized than non-HCC patients based on their WL survival as primary outcome. METHODS Restrospective cohort study including patients listed for elective OLT from January 2013 to January 2016. RESULTS 165 patients with cirrhosis were listed for OLT: 64 in the HCC group (38.78%) and 101 in the non-HCC group (61.22%). Outcomes (HCC vs. non-HCC) were: OLT in 75.51% vs. 64.37%; death or dropout due to worsening in 20.41% vs. 27.59%, and delisting because of improvement in 4.08% vs. 8.05%. HCC patients had a significantly higher WL survival rate (HR = 0.45; 95% CI: 0.21-0.96); lower MELD score at transplantation (21 [20-24] vs. 24 [20-30]; p = 0.021); higher delta-MELD - the difference between MELD at transplantation and MELD at listing time - (3 [2-6] vs. 0 [0-5]; p = 0.024) and longer waiting time until OLT (143 [70-233] vs. 67 [21-164] days; p = 0.008). CONCLUSION Despite having to wait longer, patients with HCC showed higher WL survival than non-HCC patients.
Collapse
Affiliation(s)
- Carlos Ferre-Aracil
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - José-Luis Lledó
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Lara Aguilera
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Ana Garcia-Paredes
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Enrique Rodríguez-Santiago
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Javier Graus
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Miguel García-González
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Javier Nuño
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Adolfo López-Buenadicha
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Pedro López-Hervás
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Miguel Rodríguez-Gandía
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Francisco Gea
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Agustín Albillos
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain.
| |
Collapse
|
7
|
Makroo RN, Agrawal S, Chowdhry M, Bhatia A, Thakur UK. Red cell alloimmunization & role of advanced immunohaematological support in liver transplantation. Indian J Med Res 2017; 145:488-491. [PMID: 28862180 PMCID: PMC5663162 DOI: 10.4103/ijmr.ijmr_1974_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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. Methods: 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. Results: 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.
Collapse
Affiliation(s)
- Raj Nath Makroo
- Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aakanksha Bhatia
- Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Uday Kumar Thakur
- Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, India
| |
Collapse
|
8
|
Hayes D, Tumin D, Yates AR, Mansour HM, Nicol KK, Tobias JD, Palmer AF. Transfusion with packed red blood cells while awaiting lung transplantation is associated with reduced survival after lung transplantation. Clin Transplant 2016; 30:1545-1551. [PMID: 27653312 DOI: 10.1111/ctr.12853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of pretransplant transfusion of red blood cells on survival after lung transplantation (LTx) has not been studied. METHODS The UNOS database was queried from 2005 to 2013 to compare survival in recipients receiving a transfusion while on the LTx wait list. RESULTS Of 12 283 adult patients undergoing single or bilateral LTx from May 2005 onwards, 11 801 met inclusion criteria, among whom 512 required transfusion while on the LTx wait list. Transfusion was associated with a higher mortality hazard in unadjusted Cox proportional hazards analysis (HR=1.296; 95% CI: 1.124, 1.494; P<.001), and in a multivariable Cox model (HR=1.178; 95% CI: 1.013, 1.369; P=.033) after multiple imputation was used to complete data on covariates. Propensity score matching was used to match transfusion recipients to nonrecipients on the likelihood of having received transfusions on the wait list, calculated from characteristics at the time of listing. Unadjusted Cox regression stratified on the matched pairs also demonstrated an association between transfusion receipt on the wait list and higher post-transplant mortality hazard (HR=1.494; 95% CI: 1.127, 1.979; P=.005). CONCLUSIONS Blood transfusion while on the LTx wait list was associated with diminished patient survival after transplantation.
Collapse
Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.,Department of Surgery, The Ohio State University, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Yates
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Section of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Critical Care, Nationwide Children's Hospital, Columbus, OH, USA
| | - Heidi M Mansour
- Colleges of Pharmacy and Medicine, The University of Arizona, Tucson, AZ, USA
| | - Kathleen K Nicol
- Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Critical Care, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Andre F Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
9
|
Bajpai M, Gupta S, Jain P. Alloimmunization in multitransfused liver disease patients: Impact of underlying disease. Asian J Transfus Sci 2016; 10:136-9. [PMID: 27605851 PMCID: PMC4993083 DOI: 10.4103/0973-6247.187936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Transfusion support is vital to the management of patients with liver diseases. Repeated transfusions are associated with many risks such as transfusion-transmitted infection, transfusion immunomodulation, and alloimmunization. Materials and Methods: A retrospective data analysis of antibody screening and identification was done from February 2012 to February 2014 to determine the frequency and specificity of irregular red-cell antibodies in multitransfused liver disease patients. The clinical and transfusion records were reviewed. The data was compiled, statistically analyzed, and reviewed. Results: A total of 842 patients were included in our study. Alloantibodies were detected in 5.22% of the patients. Higher rates of alloimmunization were seen in patients with autoimmune hepatitis, cryptogenic liver disease, liver damage due to drugs/toxins, and liver cancer patients. Patients with alcoholic liver disease had a lower rate of alloimmunization. The alloimmunization was 12.7% (23/181) in females and 3.17% (21/661) in males. Antibodies against the Rh system were the most frequent with 27 of 44 alloantibodies (61.36%). The most common alloantibody identified was anti-E (11/44 cases, 25%), followed by anti-C (6/44 cases, 13.63%). Conclusion: Our findings suggest that alloimmunization rate is affected by underlying disease. Provision of Rh and Kell phenotype-matched blood can significantly reduce alloimmunization.
Collapse
Affiliation(s)
- Meenu Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shruti Gupta
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Priyanka Jain
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
10
|
ElAnsary M, Hanna MOF, Saadi G, ElShazly M, Fadel FI, Ahmed HA, Aziz AM, ElSharnouby A, Kandeel MMT. Passenger lymphocyte syndrome in ABO and Rhesus D minor mismatched liver and kidney transplantation: A prospective analysis. Hum Immunol 2015; 76:447-52. [PMID: 25842056 DOI: 10.1016/j.humimm.2015.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 02/04/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
The increasing demand for solid organs has necessitated the use of ABO and Rhesus (Rh) D minor mismatched transplants. The passenger lymphocyte syndrome (PLS) occurs when donor lymphocytes produce antibodies that react with host red blood cell (RBC) antigens and result in hemolysis. Our aim was to evaluate prospectively the role of PLS in post transplant anemia and hemolysis in ABO and RhD minor mismatched recipients of liver and kidney grafts and to study the association of PLS with donor lymphocyte microchimerism. We examined 11 liver and 10 kidney recipients at Day +15 for anemia, markers of hemolysis, direct antiglobulin test and eluates, and serum RBC antibodies. Microchimerism was determined in peripheral blood lymphocytes by genotyping of simple sequence length polymorphisms encoding short tandem repeats. Immune hemolytic anemia and anti-recipient RBC antibodies were observed in 2 out of 11 liver (18.2%) and 2 out of 10 kidney (20%) transplants. RBC antibody specificity reflected the donor to recipient transplant, with anti-blood group B antibodies identified in 2 cases of O to B and 1 case of A to AB transplants while anti-D antibodies were detected in 1 case of RhD-negative to RhD-positive transplant. Donor microchimerism was found in only 1 patient. In conclusion, passenger lymphocyte mediated hemolysis is frequent in minor mismatched liver and kidney transplantation. Recognizing PLS as a potential cause of post transplant anemia may allow for early diagnosis and management to decrease the morbidity and mortality in some patients.
Collapse
Affiliation(s)
- Mervat ElAnsary
- Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | | | - Gamal Saadi
- Department of Internal Medicine and Nephrology, Cairo University, Cairo, Egypt
| | | | - Fatina I Fadel
- Department of Pediatric Nephrology, Cairo University, Cairo, Egypt
| | | | | | | | | |
Collapse
|
11
|
Baleotti W, Ruiz MO, Fabron A, Castilho L, Giuliatti S, Donadi EA. HLA-DRB1*07:01 allele is primarily associated with the Diego a alloimmunization in a Brazilian population. Transfusion 2014; 54:2468-76. [PMID: 24724911 DOI: 10.1111/trf.12652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Diego blood group presents a major polymorphic site at Residue 854, causing a proline (Di(b) antigen) to leucine (Di(a) antigen) substitution. Di(a) alloimmunization has been observed among Asian and Native South American populations. Considering that Brazilians represent a genetically diverse population, and considering that we have observed a high incidence of Di(a) alloimmunization, we typed HLA-DRB1 alleles in these patients and performed in silico studies to investigate the possible associated mechanisms. STUDY DESIGN AND METHODS We studied 212 alloimmunized patients, of whom 24 presented immunoglobulin G anti-Di(a) , 15 received Di(a+) red blood cells and were not immunized, and 1008 were healthy donors. HLA typing was performed using commercial kits. In silico analyses were performed using the TEPITOPEpan software to identify Diego-derived anchor peptide binding to HLA-DRB1 molecules. Residue alignment was performed using the IMGT/HLA for amino acid identity and homology analyses. RESULTS HLA-DRB1*07:01 allele was overrepresented in Di(a) -alloimmunized patients compared to nonimmunized patients and to healthy donors. Two motifs were predicted to be potential epitopes for Di(a) alloimmunization, the WVVKSTLAS motif was predicted to bind several HLA-DR molecules, and the FVLILTVPL motif exhibited highest affinity for the HLA-DRB1*07:01 molecule. Pocket 4 of the DRB1*07:01 molecule contained specific residues not found in other HLA-DRB1 molecules, particularly those at Positions 13(Y), 74(Q), and 78(V). CONCLUSION Individuals carrying the HLA-DRB1*07:01 allele present an increased risk for Di(a) alloimmunization. The identification of susceptible individuals and the knowledge of potential sensitization peptides are relevant approaches for transfusion care, diagnostic purposes, and desensitization therapies.
Collapse
Affiliation(s)
- Wilson Baleotti
- Faculty of Medicine of Marília (FAMEMA), Marília, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
12
|
Mushkbar M, Watkins E, Doughty H. A UK single-centre survey of red cell antibodies in adult patients undergoing liver transplantation. Vox Sang 2013; 105:341-5. [DOI: 10.1111/vox.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/30/2013] [Accepted: 05/03/2013] [Indexed: 12/20/2022]
Affiliation(s)
| | - E. Watkins
- NHS Blood and Transplant; Birmingham; UK
| | | |
Collapse
|
13
|
Is Female Sex a Risk Factor for Red Blood Cell Alloimmunization After Transfusion? A Systematic Review. Transfus Med Rev 2012; 26:342-53, 353.e1-5. [DOI: 10.1016/j.tmrv.2011.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
14
|
|
15
|
Sanz C, Ghita G, Franquet C, Martínez I, Pereira A. Red-blood-cell alloimmunization and female sex predict the presence of HLA antibodies in patients undergoing liver transplant. Vox Sang 2010; 99:261-6. [DOI: 10.1111/j.1423-0410.2010.01347.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Luzo Â, Pereira F, de Oliveira R, Azevedo P, Cunha R, Leonardi M, Leonardi L, Cardoso A, Caruy C, Ataíde E, Boin I. Red Blood Cell Antigen Alloimmunization in Liver Transplant Recipients. Transplant Proc 2010; 42:494-5. [DOI: 10.1016/j.transproceed.2010.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Abstract
PURPOSE OF REVIEW Prevention of excessive blood loss is an important issue in the perioperative management of liver transplantation. This review describes changing trends in blood products use, risk predicting of blood transfusion, variability in use and practices, as well as transfusion safety during liver transplantation. RECENT FINDINGS Over the last 20 years, the average use of blood products per case has considerably decreased. There are marked interinstitutional differences in blood use. Differences in patient population characteristics and surgical techniques are a partial explanation, but differences in transfusion practices probably account for a substantial part of the variability. Recent data have sparked off ongoing controversy relating to volume replacement therapy and its impact on blood loss. New studies emphasize the risks associated with transfusion in liver transplantation. SUMMARY Recent studies call for continuing every reasonable effort to minimize the use of blood components and can guide us in new approaches to this vital problem.
Collapse
|
18
|
Treatment of acute cellular kidney allograft rejection with T10B9.1A-31A anti T-cell monoclonal antibody. Transplant Proc 1989; 2008:715769. [PMID: 19277202 PMCID: PMC2652582 DOI: 10.1155/2008/715769] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 12/28/2008] [Indexed: 11/17/2022]
Abstract
The authors reviewed the passenger lymphocyte syndrome (PLS) that has appeared after transplantation. The definition, mechanism, serological, clinical features, and treatment for PLS after solid organ transplantation, especially liver transplantation, are described. The PLS refers to the clinical phenomenon of alloimmune hemolysis resulting from the adoptive transfer of viable lymphocytes from donor during solid organ or hematopoietic stem cell transplant. Sometimes, it is very severe and may cause “unexplained” hemolysis during the postoperative period. The authors reviewed literature about the PLS in liver transplantation.
Collapse
|