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Characterising the challenges of managing difficult red blood cell alloantibodies in liver transplant recipients
  1. Yevgen Chornenkyy1,
  2. Margaret Catherine Fink2,
  3. Christopher Felicelli3,
  4. Sean R Stowell4,
  5. Glenn Eugene Ramsey3,
  6. Guang-Yu Yang3
  1. 1Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Pathology and Immunology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  3. 3Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Yevgen Chornenkyy, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA; ychornen{at}


Aims Formation of red blood cell alloantibodies (RBCAs) complicates transfusion support in liver transplantation (LT). Difficult RBCAs (DAs, >3 antibodies or antibodies for which <25% donors are antigen negative) further challenge care. This study characterises DA outcomes relative to non-difficult RBCAs (NDAs).

Methods Single-centre, retrospective analysis of LT patients (2002–2021). RBCAs were defined as clinically significant antibodies. DAs were compared with NDAs.

Results 89 patients had clinically significant RBCAs (DA=50, NDA=39). More DAs were anti-Jka, anti-M; fewer were anti-E, anti-K (all p<0.05). DA patients often had multiple antibodies (44% vs 12.8% NDA, p=0.0022). Probability of finding antigen-negative blood was lower for DAs (17.4% vs 68.1% NDA, p<0.0001) as was RBCs received (9.4 vs 14.7 units in NDA, p=0.0036). Although survival was similar, patients with DAs had more adverse reactions (8% vs 0%, p=0.128). Some antibodies appeared to occur with specific liver diseases (such as primary sclerosing cholangitis, alcoholic steatohepatitis and recurrent disease); however, due to low sample size, definitive conclusions cannot be made.

Conclusions DA LT recipients contain >1 RBCA, have a lower probability of finding antigen negative blood and may experience more adverse transfusion event (ATE). Despite this, the incidence of ATEs was still quite low.

  • Transfusion Medicine
  • Transfusion Reaction

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Vikram Deshpande.

  • X @YChornenkyy

  • Contributors The authors confirm contribution to the paper as follows: study conception and design: YC, GER; data collection: YC, MCF; analysis and interpretation of results: YC, MCF, CF, SRS, GER, GY; draft manuscript preparation: YC, MCF, CF; manuscript revisions: GER, SRS, GY. Guarantor: YC. All authors reviewed the results and approved the final version of the manuscript.

  • Funding This research was supported by an institutional grant from the Northwestern University Department of Pathology Resident Research Committee.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.