title: Perioperative blood transfusion affects hepatitis C virus (HCV)-specific immune responses and outcome following liver transplantation in HCV-infected patients.
abstract: OBJECTIVE
  Perioperative factors can affect outcomes of liver transplantation (LT) in recipients with hepatitis C virus (HCV) infection. This study was conducted to investigate whether the immunomodulatory effects of packed red blood cells (PRBC) and platelets administered in the perioperative period might affect immune responses to HCV and thus outcomes in LT recipients.
  
  
  METHODS
  Data for a total of 257 HCV LT recipients were analysed. Data on clinical demographics including perioperative transfusion (during and within the first 24 h), serum cytokine concentration, HCV-specific interferon-γ (IFN-γ) and interleukin-17 (IL-17) producing cells, and outcomes including graft and patient survival were analysed.
  
  
  RESULTS
  Patient survival was higher in HCV LT recipients who did not receive transfusions (Group 1, n = 65) than in those who did (Group 2, n = 192). One-year patient survival was 95% in Group 1 and 88% in Group 2 (P = 0.02); 5-year survival was 77% in Group 1 and 66% in Group 2 (P = 0.05). Group 2 had an increased post-transplant viral load (P = 0.032) and increased incidence of advanced fibrosis at 1 year (P = 0.04). After LT, Group 2 showed increased IL-10, IL-17, IL-1β and IL-6, and decreased IFN-γ, and a significantly increased rate of IL-17 production against HCV antigen. Increasing donor age (P = 0.02), PRBC transfusion (P < 0.01) and platelets administration were associated with worse survival.
  
  
  CONCLUSIONS
  Transfusion had a negative impact on LT recipients with HCV. The associated early increase in pro-HCV IL-17 and IL-6, with decreased IFN-γ, suggests that transfusion may be associated with the modulation of HCV-specific responses, increased fibrosis and poor transplant outcomes.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Subramanian
authors.forename: Ankit
authors.initials: A
authors.lastname: Bharat
authors.forename: Neeta
authors.initials: N
authors.lastname: Vachharajani
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crippin
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.forename: Thalachallour
authors.initials: T
authors.lastname: Mohanakumar
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D058504:Th17 Cells / Q000276:immunology / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016207:Cytokines