Blood banking in solid organ transplantation

Abstract

: Over 150,000 organ transplants are performed annually worldwide, and transfusion medicine support is crucial for each patient. Liver transplants have posed the greatest challenge for transfusion support, including 4–9% rates of preoperative red blood cell (RBC) alloimmunization, and higher-end blood use is associated with adverse outcomes. However, with effective patient blood management, means/medians of 4–9 allogeneic RBC units per case and 75th percentiles of 7–12 units or lower are reported. Heart or lung transplant RBC transfusions averaged around 3 units, but COVID-19 lung transplants needed a median 8 units (75th percentile 15) due to dense adhesions. Passenger lymphocyte syndrome due to donor anti-A/B induce hemolysis after 6% of ABO-unmatched kidneys, 19% of livers and 29% of intestinal transplants. ABO-incompatible transplants are achieved by desensitization, A subgroup organs, or tolerance in infants. However, interlaboratory reproducibility of anti-A/B titers in these patients remains problematic. ABH structures are predominantly type 2 in RBCs and hearts, type 4 in kidneys and secretor-dependent type 1 in liver bile ducts and arteries. These anatomic differences suggest that anti-A/B assessments and therapeutic adsorptions might be improved by using organ-tailored ABH glycans. Therapeutic plasma exchange (TPE) and extracorporeal photopheresis (ECP) are widely employed for antibody removal and rejection treatment. As organ transplantation expands globally, transfusion medicine will continue to be integral to patient care.