Blood transfusion practices in liver transplantation.

Abstract

Sir, We laud the efforts taken by the Indian Journal of Anaesthesia in bringing out the September-October 2014 issue on concerns and safe practices of blood transfusion. We found the article by Chidananda Swamy[1] on ‘blood transfusion practices in liver transplantation’ very interesting. An important aspect is however missed which we would like to highlight. There are concerns associated with blood component transfusion in ABO and Rh-incompatible organ transplantations which are seen with increasing regularity. Being of incompatible blood group, to overcome the risk of hyperacute and acute rejection, the recipients are desensitised pre-operatively by antibody removal techniques such as therapeutic plasma exchange, double-filtration plasmapheresis, and antigen-specific immunoadsorption in addition to use of immunosuppressant medications and immunoglobulins (IGs). The pre-operative acceptable isoagglutinine titre, although varies in different institutions, is generally 1:8.[2] In such a delicate and balanced situation, any blood component transfusion outside the recommendation can lead to resensitisation, jeopardise the graft function and lead to hyperacute or acute antibody-mediated rejection. As an institutional protocol, we follow the table below [Table 1] while deciding upon the group of the blood component for the recipient. Till now we have done 24 ABO-incompatible renal transplantations with use of perioperative blood products in 10 of them as per the institutional protocol and have not faced any transfusion-related complications. Table 1 Our protocol for use of blood products in ABO incompatible recipients For Rh-incompatible (Rh positive donor and Rh negative recipient) transplantations, two main considerations are: blood product management and RhIG prophylaxis especially in a female patient in reproductive age group. Packed red blood cell should be Rh-compatible with the recipient's blood type and platelet concentrate, fresh frozen plasma and cryoprecipitate should be Rh-compatible with the donor.[3]