Extensive red blood cell matching considering patient alloimmunization risk.

BACKGROUND AND OBJECTIVES: Red blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is advised, encompassing not only the ABO-D blood groups but also the most clinically relevant minor antigens: C, c, E, e, K, Fya, Fyb, Jka, Jkb, S and s. This study incorporates patient-specific data and the clinical consequences of mismatching into the allocation process. MATERIALS AND METHODS: We have redefined the MINimize Relative Alloimmunization Risks (MINRAR) model to include patient group preferences in selecting RBC units from a finite supply. A linear optimization approach was employed, considering both antigen immunogenicity and the clinical impact of mismatches for specific patient groups. We also explore the advantages of informing the blood bank about scheduled transfusions, allowing for a more strategic blood distribution. The model is evaluated using historical data from two Dutch hospitals, measuring shortages and minor antigen mismatches. RESULTS: The updated model, emphasizing patient group-specific considerations, achieves a similar number of mismatches as the original, yet shifts mismatches among patient groups and antigens, reducing expected alloimmunization consequences. Simultaneous matching for multiple hospitals at the distribution centre level, considering scheduled demands, led to a 30% decrease in mismatches and a 92% reduction in shortages. CONCLUSION: The reduction of expected alloimmunization consequences by incorporating patient group preferences demonstrates our strategy's effectiveness for patient health. Substantial reductions in mismatches and shortages with multi-hospital collaboration highlights the importance of sharing information in the blood supply chain.

Sample collection for pre-transfusion crossmatching: Benefits of using an electronic identification system.

BACKGROUND: Transfusion of ABO blood group-mismatched blood or administration to the wrong recipient may result in fatal adverse events. To prevent these types of errors, various strategies have been employed. Recently, we developed a novel sample collection workflow for the pre-transfusion crossmatching test and patient recognition. This study aimed to analyse the usage of the new workflow and improvements in outcomes. METHODS: We analysed the number of crossmatching and wrong-patient errors among the blood transfusion cases during 3 years of data collection (from August 2018 to July 2021). From May 2021 to July 2021, the new workflow was implemented. Outcomes were calculated according to the department type, patient age and processing time. The sample processing time was defined as the time from placing the order to lab arrival. RESULTS: The new workflow utilisation increased from 50.7% to 80.3% and wrong-patient errors decreased annually. The new workflow was used for more adults (3001/3680 samples, 81.5%) than paediatric cases (345/522 samples, 65.5%; p < 0.001) and in general wards than in the emergency room or intensive care unit. The sample processing time differed according to ward type and timing of the request (day: 28.80, 2.43-3889.43 min, night: 3.36, 2.72-1671.47 min; p < 0.001). CONCLUSION: Wrong-patient errors were reduced without increasing sample-processing time after introducing the new workflow which included using an electronic identification system. The time needed for the blood processing differed according to the ward type, patient age, and timing of the request. Patient safety can be promoted by managing these factors and using an electronic identification system.

Implementation of a blood bank generated tube for second blood group determination: Challenges, yield, and cost.

BACKGROUND: The second blood group determination or group check sample is a process of verifying the ABO group with a second blood sample prior to transfusion. It has been used to detect errors related to wrong blood in tube (WBIT) events and reduce the risk of ABO-incompatible transfusions. To prevent the clinical team from collecting the group check sample at the same time as the first sample, a tan top tube only available from the blood bank was introduced for second blood group determinations if drawn within 24 h of the first group and screen. STUDY DESIGN AND METHODS: This is a retrospective study analyzing data from 2005 to 2020 before and after the implementation of the blood bank supplied tan top tube for group check. The number of WBIT events, transfusion delays, and health care costs were determined. RESULTS: The number of WBIT events remained unchanged throughout the time period. No delays in transfusion or procedure were reported due to the tan top tube group check. There was no increase in group O transfusions over time. In comparison to using an ethylenediaminetetraacetic acid (EDTA) tube, the tan top tube was estimated to add an extra yearly cost of $790.79 Canadian dollars. CONCLUSION: Second blood group determination using the blood bank supplied tan top tube did not increase the number of WBIT events detected but ensured an independent sample draw. A minimal incremental cost of implementing the tan top tube was noted with no delay in transfusions or procedures.

How to verify patient identity and blood product compatibility using an electronic bedside transfusion system.

Transfusion of an incorrect blood component is an important avoidable serious hazard of transfusion resulting from process errors. Our group and others have taken advantage of new technology and developed electronic transfusion systems for safe transfusion practice in a previous studies. They allow the clinical staff to correctly identify the patient and the blood product at the bedside, ensuring the right blood product is given to the right patient. This video is to demonstrate the process and not to promote any specific product. It is a follow up our previous video clip on electronic remote blood issue in a previous study. The process for correct patient identification originates from the wristband, which contains the patient identification details in a 2D barcode and is printed from the electronic patient record system. These details are associated with the blood sample through using a portable printer to produce a label for the sample tube. The patient details are scanned into the blood bank laboratory information system (LIS) and are then printed on a compatibility label by the LIS, which also contains a 2-dimensional barcode, and is then attached to the blood product. Following an initial visual check of these details by the clinical staff, the electronic bedside system requires that both the patient wristband barcode and the blood product compatibility barcode are scanned. This will electronically verify at the patient's bedside that the right unit is to be given to the right patient. This is the final step in ensuring end-to-end electronic control and safe transfusion practice.

Challenge to ABO blood type barrier in living donor liver transplantation.

ABO incompatible living donor liver transplantation has the potential to expand the donor pool for patients with end stage liver diseases on the expense of challenges to overcome immunological barriers across blood type. There is a profound impact of age on incidence and severity of antibody mediated rejection (AMR). Even children older than 1 year have chances of AMR; children aged 8 years or older have risks of hepatic necrosis similar to adult liver recipients. The mechanism of AMR is based on circulatory disturbances secondary to inflammation and injury of the vascular endothelium caused by an antibody-antigen-complement reaction. The strategy to overcome ABO blood type barrier is based on both pre-transplant desensitization and adequate treatment of this phenomenon. Nowadays, rituximab is the standard means of desensitization but unfortunately an insufficient aid to treat AMR. Because of low incidence (less than 5% in the rituximab era), in practice of AMR only some case reports about the treatment of clinical AMR are available in the literature. Initial experiences revealed that the proteasome inhibitor, bortezomib might be a promising treatment based on its capacity to deplete plasma cell agents. Although ABO blood type barrier has been counteracted in 95% of patients by applying "rituximab-desensitization", many issues, such as prediction of high-risk patients of infection and AMR and secure treatment strategies for evoked AMR, remain to be resolved.

Management of patients with rare blood groups in maternity.

We report on our experiences since 2010 with pregnant women with rare blood types. The lack of compatible blood is a challenge for the anaesthetist whose priority is to prevent and treat anaemia in late pregnancy in order to avoid immunisation after transfusion of incompatible blood. In our hospital, the blood type is checked during the first obstetric consult, which is variable, starting from the fourth month of pregnancy. Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 weeks of gestation: WG) due to the late inscription for obstetrics consult, resulting in even later anaesthetic visit. In our 13 patients, the most common blood systems are Duffy, MNS, and RH. 61.5% of the patients have associated antibodies (anti-MNS5). The majority of patients received iron with significant increase of ferritin (17.24 ± 12.95 µg/L versus 262.2 ± 404.4 µg/L, p = .033). Six of the patients had 2-3 injections of EPO between 29 - 36 + 1 WG. There were no transfers for paediatric management of haemolytic disease in the newborn following the birth. Overall, this treatment of patients with a rare blood group has also changed our practices for the follow-up of other pregnant women, and ferritin is more regularly prescribed.Impact statementWhat is already known on this subject? For rare blood groups, the frequency in the general population is less than 1/4000. The most common antibodies at risk of haemolytic disease and 'hydrops fetalis' are anti-D, anti-E, anti-C, and anti-K. The survey of pregnant women with a rare blood type takes into account the maternal risk of 'transfusion deadlock' and haemolytic disease of the newborn.What do the results of this study add? Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 WG) due to the late inscription for obstetrics consults at Maternity. The most common blood systems are Duffy, MNS, RH, and 61.5% of the patients have associated antibodies (anti-MNS5). The most efficient treatment of prenatal anaemia was iron perfusions who allowed significant increase of ferritin and a maternal haemoglobin concentration of 12.1±1.46 g/dL in the ninth month of pregnancy.What are the implications of these findings for clinical practice and/or further research? A pregnant woman with a rare blood group is a situation that requires a technical platform specialised in haemorrhagic risk and a multidisciplinary team, including a blood bank as well as anaesthetic and obstetrical teams, with excellent interdisciplinary coordination.

Trasplante renal de donante vivo ABO incompatible. Estudio de 48 pacientes tras desensibilización / ABO-incompatible living-donor kidney transplantation: Study of 48 patients after desensitisation

ANTECEDENTES: El trasplante renal de donante vivo ABO incompatible era considerado una contraindicación absoluta. Desde hace años, se realiza con buenos resultados. OBJETIVO: Nuestro objetivo es mostrar los resultados de este tipo de trasplante realizado en nuestro hospital. MÉTODOS: Estudiamos 48 pacientes con una edad media de 50,9 ± 10,9 años. Seguimiento 44,6 ± 30,9 meses. Acondicionamiento: rituximab 375mg/m2, tacrolimus, micofenolato mofetilo o micofenolato sódico, prednisona, plasmaféresis/inmunoadsorción e inmunoglobulina intravenosa. Títulos de isoaglutininas aceptados para trasplantar: IgG e IgM inferiores a 1:8. RESULTADOS: Isoaglutininas preproceso: IgG 1:124 ± 1:140, IgM 1:77 ± 1:55. Tras 6 ± 3 sesiones, la IgG descendió a < 1:8 en 47 pacientes, a<1:16 en uno; la IgM fue < 1:8 en todos. Veinticuatro pacientes (50%) presentaron hematoma, 7 reintervención (14,6%) y 29 (60%) necesitaron transfusión. Al quinto año presentaron rechazo agudo 5 pacientes (8,7%), CMV 9 (19,7%), viremia BK 5 (12,4%), diabetes postrasplante 10 (23,4%), linfocele 3 (6,4%). La supervivencia del paciente fue del 97,1% al quinto año y la del injerto, del 95,7% al año y del 93% al quinto año. Pérdida de injerto: trombosis (n = 1), rechazo mixto (n = 1) y exitus (n=2). La creatinina al año y a los 3 años fue de 1,4 ± 0,4 mg/dl y de 1,3 ± 0.3 mg/dl al quinto año. La proteinuria al año, a los 3 y a los 5 fue de 0,2 ± 0,2 g/24 h. CONCLUSIONES: El trasplante renal de donante vivo ABO incompatible tras acondicionamiento con rituximab, plasmaféresis/inmunoadsorción e inmunoglobulinas es una opción válida y ofrece excelentes resultados de supervivencia, con una baja incidencia de rechazo agudo sin aumento de complicaciones infecciosas. Se evidencia una mayor tendencia al sangrado postoperatorio

BACKGROUND: ABO-incompatible living-donor kidney transplantation was regarded as an absolute contraindication. However, it has been carried out for years with good outcomes. OBJECTIVE: Our aim was to show the results obtained with this technique in our hospital. METHODS: Forty-eight patients with a mean age of 50.9 ± 10.9 years were included. Follow-up was 44.6 ± 30.9 months. Conditioning: rituximab 375 mg/m2, tacrolimus, mycophenolate mofetil or mycophenolate sodium, prednisone, plasmapheresis/immunoadsorption and intravenous immunoglobulin. Accepted IgG and IgM titres for transplantation: < 1:8. RESULTS: Pre-process IgG titre 1:124 ± 1:140, IgM titre 1:77 ± 1:55. After 6 ± 3 sessions, IgG decreased to < 1:8 in 47 patients and to < 1:16 in one. IgM was < 1:8 in all cases. Twenty-four patients (50%) had haematoma, 7 re-intervention (14.6%), 29 (60%) required transfusion. At 5 years, acute rejection had occurred in 5 cases (8.7%), CMV infection in 9 (19.7%), BK viraemia in 5 (12.4%), post-transplant diabetes in 10 (23.4%) and lymphocele in 3 (6.4%). Patient survival was 97.1% at 5 years and graft survival 95.7% at one year and 93% at 5 years. Causes of graft loss: thrombosis (n = 1); mixed rejection (n = 1); and death (n = 2). Serum creatinine levels were 1.4 ± 0.4 mg/dl at one and 3 years and 1.3 ± 0.3 mg/dl at 5 years. Proteinuria was 0.2 ± 0.2 g/24 h at one, 3 and 5 years. CONCLUSIONS: ABO-incompatible living-donor kidney transplantation after conditioning with rituximab, plasmapheresis/immunoadsorption and immunoglobulins is a valid option offering excellent outcomes. There is a low incidence of acute rejection and no increase in infectious complications. An increased tendency for postoperative bleeding was found

Transfusion medicine: A research agenda for the coming years.

The important scientific and clinical advances of the last century in transfusion medicine include methods for avoiding hemolytic transfusion reactions and preventing transmission of viral infectious diseases. The next great clinical advances will require improving the efficacy and safety of transfusions, as well as acknowledgement of the now proven serious complications of transfusion, including nosocomial infection, thrombosis, inflammation and multi-organ failure. Possible strategies include (1) universal leukoreduction to mitigate transfusion immunomodulation effects and improve storage conditions, (2) minimizing transfusion of ABO incompatible antibodies and cellular/soluble antigens, (3) substituting use of safer solutions for normal saline during apheresis, component infusion and washing (4) new techniques to improve the efficacy and safety of blood components, including improved storage solutions/conditions, supernatant removal by washing, and rejuvenation and (5) maximizing the risk to benefit ratio of transfusions by employing more restrictive and physiologic indications for transfusion (including patient blood management) and improving clinical decision making through novel laboratory and bedside tests such as thromboelastography.

Noninfectious transfusion-associated adverse events and their mitigation strategies.

Blood transfusions are life-saving therapies; however, they can result in adverse events that can be infectious or, more commonly, noninfectious. The most common noninfectious reactions include febrile nonhemolytic transfusion reactions, allergic transfusion reactions, transfusion-associated circulatory overload, transfusion-related acute lung injury, and acute and delayed hemolytic transfusion reactions. These reactions can be asymptomatic, mild, or potentially fatal. There are several new methodologies to diagnose, treat, and prevent these reactions. Hemovigilance systems for monitoring transfusion events have been developed and demonstrated decreases in some adverse events, such as hemolytic transfusion reactions. Now vein-to-vein databases are being created to study the interactions of the donor, product, and patient factors in the role of adverse outcomes. This article reviews the definition, pathophysiology, management, and mitigation strategies, including the role of the donor, product, and patient, of the most common noninfectious transfusion-associated adverse events. Prevention strategies, such as leukoreduction, plasma reduction, additive solutions, and patient blood management programs, are actively being used to enhance transfusion safety. Understanding the incidence, pathophysiology, and current management strategies will help to create innovative products and continually hone in on best transfusion practices that suit individualized patient needs.

Multiplex blood group typing by cellular surface plasmon resonance imaging.

BACKGROUND: Blood-group typing of donors and patients is essential to avoid incompatible transfusions. Transfusion of incompatible RBCs may result in alloimmunization complicating future transfusions or in the presence of antibodies in adverse reactions. With more than 300 blood group antigens identified, it is difficult to provide fully compatible blood. Currently, standard practice is to match for the most immunogenic antigens. While the current agglutination-based RBC-typing methods are reliable for testing a selected number of antigens, they are not easily adaptable for high-throughput multiplex blood typing beyond the current standard. STUDY DESIGN AND METHODS: Surface plasmon resonance (SPR) is a label-free method to follow molecular-and, very recently, also cellular-interactions in real time. Demonstration of binding of RBCs to blood group antigen-specific antibodies by SPR has already been achieved. Here, we demonstrate the generation of an SPR array equipped with clinically relevant blood group antibodies (A, B, and Rh blood groups). To validate this method, we blindly compared typing of 946 blood donors with results of current diagnostic agglutination-based methods. RESULTS: RBC typing was achieved by monitoring RBC binding to blood group-specific antibodies on the sensor simultaneously within 5 minutes per sample. Regeneration of the chip was robust, allowing for typing of at least 100 samples. The typing results gave a 100% match with classical serology with all antibodies tested besides anti-E/e monoclonals, which gave inconsistent results due to low antibody specificity. CONCLUSION: This study demonstrates that SPR-based RBC typing for multiple antigens can be realized simultaneously with high-quality antibodies, enabling reduced hands-on time and possibly improving cost efficiency.

Efficacy of three consecutive therapeutic plasma exchanges in major ABO-incompatible hematopoietic stem cell transplantation.

INTRODUCTION: We retrospectively analyzed data of recipients who underwent three consecutive therapeutic plasma exchanges (TPEs) before major ABO-incompatible (ABOi) hematopoietic stem cell transplantation (HSCT) in our hospital from 2012 to 2017 and evaluated the efficacy of TPE for successful ABOi HSCT. MATERIALS AND METHODS: We investigated the efficacy of TPE in 29 recipients with major ABOi HSCT based on the following: (1) requirement of red blood cell (RBC) transfusion during 100 days, (2) erythrocyte engraftment by reticulocyte count at 3 months, and (3) erythropoiesis recovery by bone marrow examination at 1 month and 3 months after ABOi HSCT. RESULTS: IgM and IgG donor-specific isoagglutinins (DSIs) of 31 cases of TPE were significantly decreased after three consecutive TPEs (IgM median, 1:32 to 1:2, P < .0001; IgG median, 1:256 to 1:8, P < .0001). We divided a total of 31 TPEs into two groups depending on their final DSI titers after TPE (group F, DSI > 1:16; group S, DSI ≤ 1:16). RBC transfusions were required more by group F (median, 12 units) than those by group S (median, 2 units, P = .001). Relative frequencies of erythrocyte engraftment and normal erythropoiesis after ABOi HSCT showed higher tendencies in group S than those in group F. DISCUSSION: Our study demonstrated that three consecutive TPEs were effective in reducing DSI titer in major ABOi HSCT. Reduction of pretransplant DSI in recipients could decrease requirement for RBC transfusion. Three consecutive TPEs are necessary for successful erythrocyte engraftment and normal erythropoiesis in this setting.

Evaluating safety and cost-effectiveness of platelets stored in additive solution (PAS-F) as a hemolysis risk mitigation strategy.

BACKGROUND: Platelet inventory constraints can result in minor ABO incompatibility and possible hemolysis. The aims of this study were to determine the reduction of isoagglutinin in titers of platelets stored in additive solution (PAS) and compare its safety, efficiency, and cost-effectiveness with full-volume and plasma-reduced platelets. STUDY DESIGN AND METHODS: Isoagglutinin titers were performed in paired whole blood donor samples and apheresis platelets collected in PAS (PAS-PLT) aliquot samples by the tube method. RESULTS: A total of 149 pairs of donor/platelet samples were tested: 75 group O, 59 group A, and 15 group B. For group O donor samples, the median anti-A IgG and IgM were 64 and 16, respectively, and the median anti-B IgG and IgM were 64 and 16, respectively. For group O PAS-PLT samples the mean anti-A IgG and IgM, and anti-B IgG and IgM were 32 and 8, and 16 and 8, respectively. For group A donor samples, the mean anti-B IgG and IgM was 8 in both cases; and both titers decreased to 2 in PAS-PLT. For group B donor samples, mean anti-A IgG and IgM was 16 in both cases; and both titers decreased to 4 in PAS-PLT. PAS-PLT demonstrated a net reduction in cost and improved efficiency when compared to plasma reduction. The use of PAS-PLT resulted in a 40% reduction of allergic transfusion reactions. CONCLUSION: The use of PAS decreases plasma isoagglutinin titers, transfusion reactions, and is cost-effective when compared to routine plasma reduction as a strategy to mitigate hemolysis risk from minor incompatible platelet transfusion.

Comparative Evaluation of Five Different Methods of Anti-ABO Antibody Titration: An Aid for ABO-Incompatible Organ Transplants.

The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t-test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti-A (128) and anti-B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti-A and anti-B titers. Average agreements between the DTT-applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti-A (κ = 0.473) and anti-B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.

Long-term Outcomes of ABO-incompatible Pediatric Living Donor Liver Transplantation.

BACKGROUND: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been performed to compensate for donor shortage. To date, few studies have reported detailed B-cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT. METHODS: Twenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age < 18; n = 10). RESULTS: There were no significant differences in the incidence of infection, vascular complications, biliary complications, and acute cellular rejection between ABOi and non-ABOi groups. The cumulative graft survival rate at 1, 3, and 5 years for non-ABOi group were 92.1%, 87.0%, and 86.1%, and those for ABOi group were 82.8%, 82.8%, and 78.2%, respectively. Rituximab-based desensitization protocol could be performed safely, and reduced CD19+ lymphocyte counts effectively. Although rituximab-treated ABOi group showed comparable clinical outcomes and graft survival rate, 2 patients developed antibody-mediated rejection. CONCLUSIONS: ABOi LDLT is a feasible option for pediatric end-stage liver disease patients. However, it should be noted that current desensitization protocol does not completely prevent the onset of antibody-mediated rejection in several cases.

Sample collection and sample handling errors submitted to the transfusion error surveillance system, 2006 to 2015.

BACKGROUND: In Canada, transfusion-related errors are voluntarily reported to a tracking system with the goal to systematically improve transfusion safety. This report provides an analysis of sample collection (SC) and sample handling (SH) errors from this national error-tracking system. STUDY DESIGN AND METHODS: Errors from 2006 to 2015 from 23 participating sites were extracted. A survey was conducted to obtain information regarding institutional policies. Samples received in the blood bank were used to calculate rates. "Wrong blood in tube" (WBIT) errors are blood taken from wrong patient and labeled with intended patient's information, or blood taken from intended patient but labeled with another patient's information. RESULTS: A total of 42,363 SC and 14,666 SH errors were reported. Predefined low-severity (low potential for harm) and high-severity errors (potential for fatal outcomes) increased from 2006 to 2015 (low SC, SH: 13-27, 3-12 per 1000; high SC, SH: 1.9-3.7, 0.5-2.0 per 1000). The WBIT rate decreased from 12 to 5.8 per 10,000 between 2006 and 2015 (p < 0.0001). The overall WBIT rate was 6.2 per 10,000, with variability by site (median, 0.3 per 10,000; range, 0-17 per 10,000). Sites with error detection mechanisms, such as regrouping second sample requirements, had lower error rates than sites that did not (SC, SH: 12, 1 per 1000 samples vs. 17, 3 per 1000 samples; p < 0.0001). CONCLUSION: WBIT rates decreased significantly. Low-severity error rates are climbing likely due to increased ascertainment and reporting. Prevention studies are necessary to inform changes to blood transfusion standards to eliminate these errors.

ABO-incompatible Living Donor Liver Transplantation With Rituximab and Total Plasma Exchange Does Not Increase Hepatocellular Carcinoma Recurrence.

BACKGROUND: ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has a high success rate. This study compares hepatocellular carcinoma (HCC) recurrence in ABO-I LDLT with that in ABO-compatible (ABO-C) LDLT and explores the effects of rituximab prophylaxis and total plasma exchange on HCC recurrence after LDLT. METHODS: Two hundred forty patients with a diagnosis of HCC underwent LDLT between 2010 and 2015. Fifty-nine patients underwent ABO-I LDLT. RESULTS: Baseline, perioperative, and tumor characteristics did not vary between the 2 groups. The 1-, 2-, and 3-year disease-free survival rates in the ABO-I LDLT and ABO-C LDLT groups were 90.3%, 79.7%, and 73.3% and 86.7%, 79.0%, and 75.3%, respectively (P = 0.96). The overall patient survival rates for the same period in the ABO-I LDLT and ABO-C LDLT groups were 90.6%, 85.0%, and 81.9% and 88.0%, 83.5%, and 82.5%, respectively (P = 0.77). Hepatocellular carcinoma recurrence after LDLT was associated with preoperative α-fetoprotein greater than 35 ng/mL, increased tumor size, encapsulation, and microvascular invasion. ABO incompatibility was not related to HCC recurrence after LDLT. CONCLUSIONS: Hepatocellular carcinoma recurrence and patient survival in the ABO-I LDLT group are comparable to those in the ABO-C LDLT group. Rituximab prophylaxis and total plasma exchange do not increase HCC recurrence after LT.

PAS-C platelets contain less plasma protein, lower anti-A and anti-B titers, and decreased HLA antibody specificities compared to plasma platelets.

BACKGROUND: Platelets (PLTs) collected and stored in PLT additive solution Intersol (PAS-C) are presumed to reduce recipient exposure to donor plasma components; however, the effects of PAS-C on PLT supernatant composition are poorly defined. Therefore, we compared the total protein concentration, isohemagglutinin titers, and HLA antibodies in supernatants of PAS-C PLTs to plasma PLTs. STUDY DESIGN AND METHODS: Apheresis PLTs from group O blood donors were collected into either 100% donor plasma (n = 50) or a mixture of 65% PAS-C/35% donor plasma (n = 50). Within 12 hours of collection, samples of the PLT supernatant were frozen and stored. PLT supernatants were assayed for total protein concentration and anti-A and anti-B titers and screened for HLA antibodies. Samples positive for HLA antibodies were further tested using single-antigen bead assays to determine antibody strength and specificity. RESULTS: Supernatants of PAS-C PLTs had significantly lower total protein concentration and anti-A and anti-B titers compared to plasma PLTs. There was no significant difference in the number of HLA antibody screen-positive PAS-C (3/50) compared to plasma PLT supernatants (2/50); however, the HLA antibody screen-positive supernatants of PAS-C PLTs had fewer HLA specificities (2) compared to those of the plasma PLTs (18). CONCLUSION: Decreased plasma proteins likely underlie lower rates of allergic and febrile, nonhemolytic transfusion reactions from the infusion of PAS-C PLTs. Decreased anti-A and anti-B titers may prevent hemolysis from minor ABO mismatch. Lower HLA antibody specificities may mitigate transfusion-related acute lung injury.