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. 2015 Jan;42(1):8-14.
doi: 10.1159/000370260. Epub 2014 Dec 22.

Transfusion management and immunohematologic complications in liver transplantation: experience of a single institution

Pilar Solves  1 , Nelly Carpio  1 , Federico Moscardo  1 , Aima Lancharro  1 , Isabel Cano  1 , Angel Moya  2 , Rafael López-Andujar  2 , Miguel Ángel Sanz  1
Affiliations

Transfusion management and immunohematologic complications in liver transplantation: experience of a single institution

Pilar Solves et al. Transfus Med Hemother. 2015 Jan.

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% CI 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: Blood transfusion; Hemolysis; Immunohematologic event; Liver transplantation; Transfusion alloimmunization.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier curves representing cumulative patient survival according to the development or not of an immunohematologic event. p = 0.034.
Fig. 2
Fig. 2
Kaplan-Meier curves representing cumulative patient survival according to number of intraoperative RBC units transfused. p = 0.003.
See this image and copyright information in PMC

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