PT  - JOURNAL ARTICLE
AU  - Chornenkyy, Yevgen
AU  - Fink, Margaret Catherine
AU  - Felicelli, Christopher
AU  - Stowell, Sean R
AU  - Ramsey, Glenn Eugene
AU  - Yang, Guang-Yu
TI  - Characterising the challenges of managing difficult red blood cell alloantibodies in liver transplant recipients
AID  - 10.1136/jcp-2024-209399
DP  - 2024 May 15
TA  - Journal of Clinical Pathology
PG  - jcp-2024-209399
4099  - http://jcp.bmj.com/content/early/2024/05/14/jcp-2024-209399.short
4100  - http://jcp.bmj.com/content/early/2024/05/14/jcp-2024-209399.full
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information.