Human Leukocyte Antigen Class I Antibodies and Response to Platelet Transfusion in Patients Undergoing Liver Transplantation
- Resource Type
- Authors
- Johnny C. Hong; Ravi Narra; Anand Padmanabhan; Melissa Wong; Joohyun Kim; Michael A. Zimmerman; Motaz Selim
- Source
- Journal of Surgical Research. 255:99-105
- Subject
- Male
medicine.medical_specialty
Cirrhosis
medicine.medical_treatment
Blood Loss, Surgical
Platelet Transfusion
Human leukocyte antigen
Postoperative Hemorrhage
Liver transplantation
Gastroenterology
End Stage Liver Disease
03 medical and health sciences
0302 clinical medicine
HLA Antigens
Isoantibodies
Internal medicine
medicine
Humans
Platelet
Prospective Studies
Retrospective Studies
Pregnancy
biology
business.industry
Histocompatibility Testing
Middle Aged
medicine.disease
Thrombocytopenia
Liver Transplantation
Treatment Outcome
Platelet transfusion
030220 oncology & carcinogenesis
Cohort
biology.protein
Female
030211 gastroenterology & hepatology
Surgery
Antibody
business
- Language
- ISSN
- 0022-4804
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.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 antibody20%. The mean follow-up was 21.4 mo.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.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.