Intraoperative blood transfusions in highly alloimmunized patients undergoing orthotopic liver transplantation

Abstract

Intraoperative blood requirements were analyzed in patients undergoing primary orthotopic liver transplantation and divided into two groups on the basis of panel reactive antibody of pretransplant serum measured by lymphocytotoxicity testing. One group of highly sensitized patients (n = 25) had PRA values of over 70% and the second group of patients (n = 26) had 0% PRA values and were considered nonsensitized. During the transplant procedure, the 70% PRA group received considerably greater quantities of blood products than the 0% PRA group--namely, red blood cells: 21.1 +/- 3.7 vs. 9.8 +/- 0.8 units (P = 0.002), and platelets: 17.7 +/- 3.2 vs. 7.5 +/- 1.5 units (P = 0.003). Similar differences were observed for fresh frozen plasma and cryoprecipitate. Despite the larger infusion of platelets, the blood platelet counts in the 70% PRA group were lower postoperatively than preoperatively. Twenty patients in the 70% PRA group received platelet transfusions, and their mean platelet count dropped from 95,050 +/- 11,537 preoperatively to 67,750 +/- 8,228 postoperatively (P = 0.028). In contrast, nearly identical preoperative (84,058 +/- 17,297) and postoperative (85,647 +/- 12,445) platelet counts were observed in the 17 0% PRA patients who were transfused intraoperatively with platelets. Prothrombin time, activated partial thromboplastin time, and fibrinogen levels showed no significant differences between both groups. These data demonstrate that lymphocytotoxic antibody screening of liver transplant candidates is useful in identifying patients with increased risk of bleeding problems and who will require large quantities of blood during the transplant operation.

FIGURE 1

Intraoperative transfusion of red blood cells (RBC) and platelet (PLT) in 25 highly sensitized (70% PRA group) and 26 non-sensitized (0% PRA group) patients. Mean values are depicted with thick bars.

FIGURE 2

Intraoperative transfusion of fresh frozen plasma (FFP) and cryoprecipitate (CRYO) in 25 highly sensitized (70% PRA group) and 26 nonsensitized (0% PRA group) patients. Mean values are depicted by thick bars.

FIGURE 3

Correlation between preoperative blood platelet counts and intraoperative platelet transfusions in the 0% PRA group (top) and 70% PRA group (bottom).

FIGURE 4

Correlation between intraoperative transfusion of platelets (PLT) and red blood cells (RBC) in the 0% PRA group (top) and 70% PRA group (bottom).

FIGURE 5

Differential in blood platelet counts before and after operation in transfused patients in the 70% (○) and 0% PRA group (□). Mean values are depicted with thick bars.