Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution

Autores de IIS La Fe

• Pilar Solves Alcaina

  Autor

• Nelly Carpio Martinez

  Autor

• Federico Moscardo Garcia

  Autor

• Alma Lancharro

  Autor

• Isabel Cano Ferri

  Autor

• Angel Moya Herraiz

  Autor

• Rafael López Andújar

  Autor

• Miguel Ángel Sanz Alonso

  Autor

Grupos

• Hematología y Hemoterapia

• Hepatología experimental y Trasplante hepático

Abstract

Objective: Liver transplantation (LT) has traditionally been associated with major blood loss and consequently high blood transfusion requirements. Our objective was to analyze transfusion management and incidence of immunohematologic complications in patients undergoing LT at our institution. Methods: A retrospective analysis of immunohematologic events and transfusion outcomes was carried out at La Fe University Hospital in Valencia. Data from 654 patients were reviewed: 654 underwent only one LT while 36 underwent second LT. Results: Patients received a median of 3 red blood cell (RBC) concentrates, 2 platelets concentrates (PCs) and 2 fresh frozen plasma units (FFPs). Variables significantly influencing RBC transfusions were: the MELD score, hemoglobin levels, and the platelet counts before LT. 27 patients (4.1%) had a positive antibody screening before transplant. Immunohematologic events occurred in 8% of the patients, mostly in the first month after LT, and involved hemolysis in 13 cases. Mortality was significantly higher in patients developing immunohematologic disorders (42.8 vs. 18.3%; p < 0.001). In the multivariable analysis, only ABO minor incompatibility between donor and recipient significantly increased the appearance of immunohematologic incidences (OR 4.92, 95% Cl 2.31-10.50; p < 0.001). Conclusion: Transfusion management of patients that underwent LT can be complicated by immunohematologic problems. Blood banks should implement the DAT test in each transfusion to detect them.

Keywords

• Liver transplantation; Blood transfusion; Hemolysis; Immunohematologic event; Transfusion alloimmunization