Lack of Alloimmunization to the D Antigen in D- Liver Transplant Recipients Receiving D+ RBCs Perioperatively
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Resident PGY 3
Henry Ford Hospital
Background: D negative (D-) patients are routinely transfused with D- red blood cells (RBCs) due to the increased immunogenicity of the D antigen. The rate of alloimmunization to the D antigen following transfusion can be as high as 80%; however, immunosuppressed patients may be less likely to become alloimmunized. Some D- patients undergoing liver transplant may require a large number of RBC units which can risk the inventory of D- RBCs which are considered relatively rare (10-15% of donor units) as compared to D positive (D+) RBCs. So the blood bank may be forced to supply such patients with D+ RBCs due to inventory constraints. Though the process of providing D+ RBCs to D- transplant recipients is accepted in blood bank practice, the incidence of alloimmunization to the D-antigen in D- liver transplant patients has not been well defined. With a very active liver transplant program at our institution, studying the prevalence of anti-D formation in D- orthotopic liver transplant patients receiving D+ RBCs perioperatively will assist in successful patient blood management.
Methods: This was a retrospective study performed at a single large academic medical center. The study was approved by our Institutional Review Board. Electronic medical records and blood bank files for all 1045 consecutive patients who underwent orthotopic liver transplantation at Henry Ford Hospital in Detroit, Michigan, from January 2007 through December 2017 were reviewed.
Results: Twenty-three D- patients of a total of 154 D- patients (15%) received D+ blood perioperatively. The median age was 56 years (range 36-67 years); 17 (74%) were male. Two patients did not survive surgery. Four patients did not have serological follow up. Antibody screens were available on 17 patients: There was no evidence of D alloimmunization in any patient after a median follow up of 8.2 months (range 6 days - 79.4 months). Median number of D+ RBC units transfused was 8 units (range 1-66 units). We had 14 D- patients (14/154=9.1% of all D- liver transplant recipients) who presented with D alloimmunization before transplant; none of these patients was transfused with D+ blood at our institution.
Conclusion: Our study showed that there was no risk of alloimmunization to the D antigen in D- orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion of D+ RBCs in D- liver transplant recipients is an acceptable practice perioperatively in the setting of immunosuppression. This practice allows the conservation of D- RBC units for other patients in greater need.
Ahsan, Beena U.; Wlosinski, Lindsey; El-Bashir, Jaber; Nagai, Shunji; Yoshida, Atsushi; Abouljoud, Marwan; and Otrock, Zaher K., "Lack of Alloimmunization to the D Antigen in D- Liver Transplant Recipients Receiving D+ RBCs Perioperatively" (2019). Clinical Research. 56.