Human Leukocyte Antigen Class I Antibodies and Response to Platelet Transfusion in Patients Undergoing Liver Transplantation. J Surg Res 2020 Nov;255:99-105
Date
06/17/2020Pubmed ID
32543385DOI
10.1016/j.jss.2020.05.029Scopus ID
2-s2.0-85086399641 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Patients undergoing liver transplantation (LT) frequently receive platelet transfusion (PLT) to minimize their risk of hemorrhage. Alloimmunization to platelets may lead to refractoriness to PLT. Data on the implications of platelet alloimmunization in patients undergoing LT remain limited. We examined the effect of human leukocyte antigen class I (HLA-I) antibodies on PLT refractoriness and short-term outcomes after LT.
METHODS: Peritransplant clinical and PLT factors were reviewed for all adult liver or simultaneous liver-kidney transplantations from 2012 to 2017. Sensitized patients (SE) with pretransplant HLA-I calculated panel-reactive antibody ≥20% were compared with unsensitized patients (US) with calculated panel-reactive antibody <20%. The mean follow-up was 21.4 mo.
RESULTS: Alloimmunization was observed in 39% of the study cohort. SE (n = 28) received 272 PLTs, and US (n = 44) received 246 PLTs. History of pregnancy was higher among SE than US (P < 0.01); otherwise, both groups had similar clinical characteristics. SE had higher rates of PLT refractoriness (66% versus 47%; P < 0.01) than US. The mean platelet corrected count increment was lower among SE compared with US up to 100 min after PLT (P < 0.05). Alloimmunization and simultaneous liver-kidney transplantation independently predicted refractoriness on multivariate logistic regression (P < 0.05). Early allograft rejection and patient survival rates were comparable for both groups.
CONCLUSIONS: LT patients experienced high rates of HLA-I alloimmunization and PLT refractoriness. SE had higher rates of refractoriness and lower mean corrected count increment after transfusion compared with US. Our study suggests that further research to evaluate the utility of HLA-matched PLTs in HLA-I alloimmunized LT patients is warranted.
Author List
Wong M, Narra R, Selim M, Zimmerman MA, Kim J, Padmanabhan A, Hong JCAuthors
Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinRavi Kishore Narra MD Assistant Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Blood Loss, SurgicalEnd Stage Liver Disease
Female
HLA Antigens
Histocompatibility Testing
Humans
Isoantibodies
Liver Transplantation
Male
Middle Aged
Platelet Transfusion
Postoperative Hemorrhage
Prospective Studies
Retrospective Studies
Thrombocytopenia
Treatment Outcome
