Blood transfusions in liver recipients: a conundrum or a clear benefit in the cyclosporine/tacrolimus era?
Blood transfusions are common in patients with end-stage liver disease (ESLD), and their effects on sensitization, rejection, and liver graft survival are not well known. These effects were examined in 121 recipients of primary liver grafts, surviving > or = 30 days. Ninety-six (79%) patients received transfusions before transplantation. Transfusion recipients had significantly fewer severe or recurrent rejection episodes (18%), compared with patients who did not receive transfusions (42%, P=0.006), if the first transfusion was > or = 90 days before the transplant. Patients with alcoholic ESLD (n=49) had significantly fewer severe rejection episodes when compared with the nonalcoholic (n=72) patients (12% vs. 35%, P=0.004). The transfusion benefit was, however, more apparent and significant in the nonalcoholic (26% vs. 56% in nontransfused, P=0.02) than among the alcoholic recipients (6% vs. 25%, P=0.1). This finding is, most likely, due to a combination of a higher rate of severe rejection and the statistical power of the larger number of recipients in the nonalcoholic group. This finding is further corroborated by a multivariate analysis in which blood transfusions retained their benefit (P<0.05) independent of recipient's age and diagnosis. Graft and patient survival were not significantly different in the transfused versus nontransfused groups. Transfusion recipients had a higher panel antibody (11.4+/-23.4 vs. 2.7+/-8.1, P<0.02) but no increased risk of a positive crossmatch. In liver recipients, blood transfusions diminish the risk of rejection independent of recipient's age and the cause of ESLD.
Koneru
B
B
Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103, USA.
Harrison
D
D
Rizwan
M
M
Holland
B K
BK
Ippolito
T
T
Holman
M J
MJ
Leevy
C B
CB
D000328:Adult; D001803:Blood Transfusion; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007432:Intraoperative Period; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus