ABO Incompatibility Research Articles

Impact of Donor-to-Recipient ABO Mismatch on Outcomes of Antithymocyte Globulin-Based Peripheral Blood Stem Cell-Derived Myeloablative Conditioning Haploidentical Stem Cell Transplantation

ABO incompatibility is common in hematopoietic stem cell transplantation (HSCT); however, the impact of donor-recipient ABO compatibility on transplantation outcomes in different HSCT settings is controversial. Moreover, haploidentical stem cell transplantation (haplo-SCT) with peripheral blood stem cell (PBSC)-derived grafts has not been well investigated. The present study aimed to investigate the impact of ABO incompatibility on post-transplantation outcomes, engraftment kinetics, blood product requirements, transfusion independence, and the incidence of poor graft function (PGF) in antithymocyte globulin (ATG)-based haplo-SCT with PBSC grafts during long-term follow-up. We prospectively evaluated 510 patients with hematologic malignancies who underwent haplo-SCT after myeloablative conditioning (MAC). The primary endpoint was overall survival (OS), and secondary endpoints were nonrelapse mortality (NRM), graft-versus-host disease (GVHD), relapse, neutrophil and platelet engraftment, blood transfusion requirements, transfusion independence, and the incidence of PGF. There was no significant association between ABO matching and OS, disease-free survival (DFS), relapse, NRM, grade II-IV acute GVHD, grade III-IV acute GVHD, and moderate and severe chronic GVHD. There were also no significant differences in neutrophil and platelet engraftment, blood transfusion independence, and transfusion requirements at 30, 60, 90, 180, and 365 days post-transplantation among patients with ABO matching and those with minor, major, or bidirectional ABO incompatibility. Donor-recipient ABO matching did not differ significantly according to graft function (good versus poor). ABO incompatibility status has no major impact on patient outcomes in patients with hematologic malignancies undergoing ATG-based MAC haplo-SCT with PBSC-derived grafts.

Use of Human Leukocyte Antigen (HLA)-Incompatible Platelet Units in HLA Platelet-Refractory Patients With Limited Number of or Low-Level HLA Donor-Specific Antibodies Results in Permissive Transfusions.

In human leukocyte antigen (HLA)-mediated alloimmune platelet refractoriness, HLA-incompatible platelets may produce adequate posttransfusion corrected count increment ("permissive transfusion") and increase the donor pool. To determine if a lower number of or low-level anti-HLA donor-specific antibodies (DSAs) predict permissive transfusion and could be used to prioritize platelet selection. We categorized platelets administered from 2016 to 2018 as HLA-compatible or HLA-incompatible based on presence of DSAs against the donor unit. We further divided HLA-incompatible units based on the number of DSAs and the level of DSAs (measured by mean fluorescence intensity [MFI]), where cumulative MFI ≥6000 defines high-level DSA. We compared posttransfusion corrected count increments (CCIs) and transfusion reactions among these transfusions. Of 279 HLA-selected units transfused into 26 platelet-refractory patients, we resorted to using 39 HLA-incompatible units (14%). Posttransfusion CCI and transfusion reaction frequency were similar among units targeted by 1 or low-level DSAs and HLA-compatible units. Units targeted by ≥2 distinct or high-level DSAs produced lower CCIs. Regardless of ABO compatibility, similarly HLA-categorized units yielded comparable CCIs and comparable frequency of transfusion reactions. HLA-incompatible platelets transfused across 1 or low-level DSAs were commonly permissive, whereas those transfused across ≥2 DSAs or high levels of DSA (MFI ≥6000) were nonpermissive. The use of such donor units offers transfusion services alternative platelet units for support of platelet-refractory patients.

Outcome of ABO-Incompatible Kidney Transplantation According to ABO Type of Transfused Plasma: Comparative Analysis Between "Universal" AB and Donor-Type Plasma.

We compared the clinical outcomes of recipients of ABO-incompatible (ABOi) kidney transplantation (KT) according to the blood group of the plasma transfused. We retrospectively analyzed the data of 60 recipients of ABOi-KT with blood type O and A or B donors. Demographic and clinical characteristics were compared between 2 groups of recipients: 1 group received AB plasma regardless of the donor's blood type (n = 30), and the other group received donor-type plasma (n = 30). There were no significant differences between the groups in terms of demographic characteristics. Transfusion of donor-type plasma was noninferior to transfusion of type AB plasma in terms of both rejection-free survival and rejection rate (P = .455, P = .335). There was no significant prognostic difference between the 2 groups. In terms of blood supply and inventory management, we suggest that the blood group of the plasma should match the donor's type.

Management of Minor ABO Incompatibility in Allogeneic Stem Cell Transplant by Plasma Reduction: Case Report from A Tertiary Care Private Hospital in Dhaka

Human Leukocyte Antigen (HLA) matching plays a crucial role in allogeneic SCT outcome and remains the single most important factor for donor selection. ABO blood group barrier is often crossed between patient and donor. ABO incompatibility may cause acute haemolysis due to transfer of high titter donor isohaemagglutinins contained in the graft or in paediatric patients with small blood volume. To overcome this obstacle, some amount of plasma present in progenitor cell product can be reduced. Plasma reduction can be done in many ways. For a financial constrain set up, we did the plasma reduction manually to overcome the complications and cost. Here we are presenting a case report from Bangladesh.

STUDY OF CORRELATION OF ABO AND RH INCOMPATIBILITY WITH RISK OF NEONATAL HYPERBILIRUBINEMIA IN A TERTIARY CARE HOSPITAL

Background: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with signicant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occurs in 'A' and 'B' blood group babies of O '+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia. So early intervention, at proper time, is mandatory to prevent these sequelae Methods: The aim is to determine the frequency of ABO and Rh blood group incompatibilities and associated incidence of hyperbilirubinemia for the purpose of instituting intervention for better neonatal outcomes. It was a descriptive cross-sectional study that includes 102 neonates born to mother with O or Rh-negative blood group admitted in the post-natal ward for routine newborn care. Serum bilirubin was documented in icteric neonates. Results: The incidence of ABO incompatibility in our study was 33.33% and of Rh incompatibility was 4.9%. In ABO and Rh incompatibility group, 41.17% and 20% new born respectively developed clinical jaundice. In ABO incompatibility group, majority, 64.28% did not require treatment, whereas in Rh incompatibility group 100% required treatment. In both ABO and Rh incompatibility exchange transfusion was not required. In ABO and Rh incompatibility, all new-born treated well and no kernicterus was seen. Conclusions: In ABO incompatibility, if jaundice develops, it remains in physiological limits. In presence of some aggravating conditions may present as pathological jaundice. It results in signicant morbidity but no mortality, so prevention of aggravating factors is very important, in case of ABO and Rh incompatibility.

Accurate detection of reemergent anti-donor ABO antibody is crucial for safe transfusion in ABO major incompatible HSCT patient after achieved the stages of full switch to donor type.

Dynamic monitoring ABO chimera including erythroid ABO antigen and anti-A/B is crucial to not only assess the status of erythroid engraftment but also achieve personalized safety transfusion in patients post ABO incompatible hematopoietic stem cell transplantation. Transfusion support for ABO incompatible (ABOi) HSCT patients after achieved complete alteration to donor origin still remains cautious because the instant hematopoietic status on these transplant patients possibly returned to patient origin derived from early disease relapse and graft loss or failure. We reported that reemergent anti-B in a female patients (donor/patient: B/O) at the early phase after achievement complete donor type were not effectively found from partial automatic ABO blood grouping systems, which directly resulted in differential judgement of transplantation stage for about 15 days and disturbed the optimal recommendation on transfusion support. Meanwhile, the solely alteration of ABO chimera was found and earlier than changes of other markers such as MRD diagnosis, chimerism analysis by STR-PCR and sex chromosome assays, which can be an available predictors for bad transplant outcomes such as graft failure.

Platelet transfusion practice and related transfusion reactions in a large teaching hospital.

Platelet transfusion practice varies widely since many aspects of platelet concentrate (PC) use have not been definitively determined. The objectives of this retrospective study were to present platelet transfusion practice and evaluate PC and patient characteristics, as well as their association with transfusion reaction (TR) rate. Platelet transfusions over a 5-year period were analysed regarding PC characteristics (the ABO and RhD compatibility, product type, and storage duration), patient characteristics (most responsible diagnosis, age, and gender), and TR type. A total of 46,351 PCs were transfused: 76.4% whole blood-derived (WBD) and 23.6% single donor apheresis (SDA). Three thousand seven hundred seventy-six patients received platelet transfusions: 24.7% paediatric and 75.3% adult patients, 79.6% outpatients and 20.4% inpatients. As much as 63.1% of all transfused PCs were fresh (stored for≤3 days), 98.0% ABO-identical, and 87.3% of all PCs given to RhD- patients were RhD-. PCs were mainly transfused to haemato-oncology (76.8%) and cardiovascular surgery patients (6.5%). Overall, 84 (0.18%) TRs were reported, with allergic TRs (ATRs) being the most common. Although PC ABO compatibility and storage duration, as well as patient age and gender, showed differences in TR rate, only the use of PCs in platelet additive solution (PAS) showed a statistically significant reduction of TRs (P<0.001). Transfusion practice at the University Hospital Centre Zagreb resulted in almost all patients receiving ABO and RhD identical PCs, and most of them were fresh PCs. The most important factor affecting the incidence of TRs was platelet storage solution. The use of PAS effectively reduced the rate of TRs, particularly allergic TRs.

Migration of fully covered self-expandable metallic stents used to treat anastomotic strictures after orthotopic liver transplantation: A single-center, retrospective analysis.

Insertion of a fully covered self-expandable metallic stent (FCEM) through endoscopic retrograde cholangiopancreatography is an effective solution for biliary anastomotic stricture following orthotopic liver transplantation (OLT). However, FCEM migration continues to plague patients. This study aimed to evaluate the FCEM migration rate in our center, and to investigate the factors increasing the migration risk for FCEM.The study enrolled 43 post-OLT patients with confirmed duct-to-duct AS. The effects of age, gender, albumin, alanine aminotransferase, aspartate aminotransferase (AST), γ-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, direct bilirubin, ABO (blood group system consists of four antigens) incompatibility, stricture length, FCEM brand, FCEM length, donor liver and recipient bile duct diameters, size mismatches between the donor and recipient bile ducts >2 mm, diabetes and/or hypertension status, endoscopic sphincterotomy status, the use of plastic stents or nasobiliary drainage prior to FCEM implantation, duration from OLT to FCEM placement, and OLT etiology on FCEM migration were retrospectively analyzed.The FCEM migration rate was 48.8% (21/43) at 6 months. The serum AST level was significantly higher in the migration group than that in the nonmigration group (52.48 vs 29.50 U/L, P < .05). A lower serum AST level was associated with a decreased risk of FCEM migration in post-OLT patients with duct-to-duct anastomotic stricture (hazard ratio = 0.968, 95% confidence interval: 0.940–0.996, P = .028).In this single-center, retrospective cohort study, we showed that an elevated serum AST level was a potential risk factor for FCEM migration.

Predicting Significant Hyperbilirubinemia in ABO Incompatibility: Is Cord Direct Antiglobulin Test Useful?

To study the prevalence of direct antiglobulin test (DAT) positivity and outcomes in babies with ABO incompatibility and the role of DAT in predicting need for phototherapy. This was an analytical retrospective cohort study conducted in a tertiary care hospital in South India. DAT was performed routinely in cord blood of all neonates born to O positive mothers. The case records of neonates ≥ 35weeks of gestation and birth weight > 2000gm with ABO setting born between January 2019 and December 2020 were reviewed and outcomes were analyzed. Among 2484 live births, there were 426 eligible ABO incompatible births and DAT was positive in 68(15.9%). DAT positive neonates had significantly higher peak mean bilirubin [16.02mg/dL vs. 13.68mg/dL, p = 0.00], need for phototherapy in first 24h [23(33.8%) vs. 32(8.9%), p = 0.00], need for exchange transfusion [2(2.9%) vs. 0(0%), p = 0.025] and immunoglobulin [6(8.8%) vs. 0(0%), p = 0.00]. Cord DAT showed 29.9% sensitivity, 96.9% specificity, 89.7% positive predictive value and 60.1% negative predictive value for predicting need for phototherapy. DAT positivity occurs in a significant proportion of ABO incompatible births and a "selective" cord blood DAT in neonates born to O positive mothers can identify those neonates at risk of significant hyperbilirubinemia with high diagnostic accuracy.

Retrospective analysis of direct antiglobulin test positivity at tertiary academic hospital over 10 years

BackgroundHemolytic disease of the fetus and newborn (HDFN) is a clinically significant problem that may potentially affect any pregnancy. Direct antiglobulin test (DAT) is considered to be an important test in identifying newborns who are suspected to have HDN. This study aims in reviewing data regarding a positive DAT result concerning etiology and the development of HDN over a period of 10 years. Study design and methodsA retrospective study of all neonates with a positive DAT result between January 2011 and December 2020 was performed. Data were obtained from patients' electronic hospital files, transfusion medicine databases, and medical birth records. Laboratory parameters along with clinical interventions in neonates with a DAT-positive result and a comparison group of DAT-negative neonates were performed. Results36,000 deliveries were registered in this period. 176 (2.65 %) neonates had a positive DAT result. ABO-incompatibility was the most common cause with 59.1 %; Rh incompatibility 13.8 %, minor blood group incompatibility, and other RBC-related antibodies 10.1 %, and unspecified etiology in 17 % of cases. Among DAT-positive cases, 32.7 % of neonates were diagnosed with HDN. ABO-incompatibility was the major reason as well. Initial mean total bilirubin levels were higher in the DAT-positive group than the control group (p < 0.001), and these neonates also had a lower initial hemoglobin level (p < 0.001). The need for therapeutic interventions was significantly higher in DAT-positive neonates (p < 0.001) as 86.8 % underwent phototherapy, with 32.7 %, and 17.6 % receiving exchange transfusion (ET) and intravenous immunoglobulin (IVIG), respectively. ConclusionIn conclusion, ABO incompatibility was the most common cause for neonatal DAT positivity. Besides the common causes of DAT positivity, there would be rare but important conditions that may lead to a positive result, such as antibodies passively acquired from mothers in the context of alloimmunizations or using drugs. In addition, as a high rate of therapeutic intervention was identified among neonates with a DAT-positive result, there is a crucial need for increasing awareness regarding early diagnosis of the condition, careful monitoring, and the employment of prenatal alloimmunization screening tests.

Efficacy of Double Volume Exchange Transfusion in Term Neonates with Hyperbilirubinemia Due to Abo Incompatibility

Objectives: To determine the efficacy of double volume exchange transfusion in term neonates with hyperbilirubinemia due to ABO incompatibility. Materials and Methods: This was a descriptive case series study conducted in the Neonatal Unit, Department of Pediatrics, Sheikh Zayed Hospital, Rahim Yar Khan from 30-09-2016 to 29-12-2017. Results: Total cases were 87, out of which 47 (54.02%) were males with a mean age of 4.32±1.51 days. The efficacy of double exchange transfusion was seen in 28 (32.18%) cases. Conclusion: The efficacy of double volume exchange is seen in 28 (32.18%) out of 87 cases and it is significantly high in cases when the exchange is done within the first 3 days of birth (p= 0.01). Keywords: ABO incompatibility, hyperbilirubinemia, double volume exchange transfusion.

Increasing Living Donor Liver Transplantation Using Liver Paired Exchange

Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US. This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE. A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months). LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.

Quick preparation of ABO-incompatible living donor liver transplantation for acute liver failure.

Acute liver failure is life-threatening and has to be treated by liver transplantation urgently. When deceased donors or ABO-compatible living donors are not available, ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) becomes the only choice. How to prepare ABO-I LDLT urgently is an unsolved issue. A quick preparation regimen was designed, which was consisted of bortezomib (3.5mg) injection to deplete plasma cells and plasma exchange to achieve isoagglutinin titer ≤ 1: 64 just prior to liver transplantation and followed by rituximab (375mg/m2 ) on post-operative day 1 to deplete B-cells. Eight patients received this quick preparation regimen to undergo ABO-I LDLT for acute liver failure from 2012 to 2019. They aged between 50 and 60years. The median MELD score was 39 with a range from 35 to 48. It took 4.75 ± 1.58 days to prepare such an urgent ABO-I LDLT. All the patients had successful liver transplantations, but one patient died of antibody-mediated rejection at post-operative month 6. The 3-month, 6-month, and 1-year graft/patient survival were 100%, 87.5%, and 75%, respectively. In conclusion, this quick preparation regimen can reduce isoagglutinin titers quickly and make timely ABO-I LDLT feasible for acute liver failure.

Impact of peri-transplant RBC transfusion and ABO incompatibility on acute graft-versus-host disease in pediatric hematopoietic stem cell transplant patients

It is well known that stem cell transplantation is curative for many diseases; however, graft versus host disease (GVHD), which is a common posttransplant complication, has still a substantial place among the causes of transplant-related morbidity and mortality.The association between ABO incompatibility and GVHD is controversial. There is also limited available data about the association between blood component transfusions during the peritransplant period and GVHD development in the pediatric setting.Hence, we retrospectively evaluated both the impact of ABO-mismatch and transfusions of RBC and platelets between day -7 pre-transplant and +30 post-transplant to the development of acute GVHD (aGVHD). We analyzed 139 allotransplants in 133 patients who were transplanted by myeloablative conditioning. Fifty-one patients out of 133 (36.7 %) were found to have aGVHD within +100 days post-transplantation. Of them 40 patients had grade I-II and 11 patients had grade III-IV aGVHD. Increased risk of aGVHD is associated with ABO minor mismatch (p: 0.030). Nevertheless, there was no association between ABO mismatch and severity of aGVHD. The median number of RBC transfusions in aGVHD patients was higher than the number of transfusions in patients without aGVHD; however, the difference was not statistically significant (p: 0.11). Platelet transfusion numbers were statistically similar between aGVHD patients and the patients without aGVHD (p: 0.79).In conclusion, major and bi-directional ABO-incompatibility between donors and recipients, and RBC and platelet transfusions between day -7 pretransplant and day +30 post-transplant do not contribute to aGVHD development in children undergoing HSCT by myeloablative conditioning, while ABO minor mismatch is associated with the development of aGVHD.

ABO Blood Group Incompatibility Protects Against SARS-CoV-2 Transmission.

ABO blood groups appear to be associated with the risk of SARS-CoV-2 infection, but the underlying mechanisms and their real importance remain unclear. Two hypotheses have been proposed: ABO compatibility-dependence (neutralization by anti-ABO antibodies) and ABO-dependent intrinsic susceptibility (spike protein attachment to histo-blood group glycans). We tested the first hypothesis through an anonymous questionnaire addressed to hospital staff members. We estimated symptomatic secondary attack rates (SAR) for 333 index cases according to spouse ABO blood group compatibility. Incompatibility was associated with a lower SAR (28% vs. 47%; OR 0.43, 95% CI 0.27–0.69), but no ABO dependence was detected in compatible situations. For the second hypothesis, we detected no binding of recombinant SARS-CoV-2 RBD to blood group-containing glycans. Thus, although no intrinsic differences in susceptibility according to ABO blood type were detected, ABO incompatibility strongly decreased the risk of COVID-19 transmission, suggesting that anti-ABO antibodies contribute to virus neutralization.

Neonatal ABO incompatibility, influence of blood group, and coomb's test on outcome

Background: Better understanding of the clinical characteristics of ABO hemolytic disease in neonates helps optimize care. Objective: To assess the morbidity associated with ABO incompatibility. Materials and Methods: Neonates with blood groups A or B born to mothers with blood group O were studied. Need for phototherapy (PT), intensive PT, intravenous immunoglobulin (IVIG) therapy, and packed red blood cell (PRBC) transfusions was studied. Results: The O–A group accounted for 57.2% and the O–B group 42.8%. Three-hundred and seventy-nine (46%) were Direct Coomb's test (DCT) positive. Need for PT and intensive PT was significantly higher in DCT-positive infants compared to DCT-negative infants (P < 0.001). DCT-positive infants required more PRBC transfusions (5.3% vs. 0.9%, P < 0.001) and IVIG therapy (6% vs. 0.2%, P < 0.001) compared to DCT-negative infants. Sixty percent of the blood group B infants were DCT positive compared to 35% of blood group A infants (P < 0.001). Need for PT (62% vs. 39%, P < 0.001), intensive PT (17% vs. 4%, P < 0.001), and IVIG therapy (5.4% vs. 0.8%, P < 0.001) was higher in infants with blood group B. TcB measured at median age of 12 h was predictive of the need for PT (area under the receiver operator characteristic [AUROC] =0.867) and intensive PT (AUROC = 0.917). The maximum reticulocyte percentage was predictive for both the need for IVIG therapy (AUROC = 0.978) and PRBC transfusion (AUROC = 0.863). Conclusions: DCT-positive infants and infants with blood group B suffered significantly higher adverse outcomes. TcB measured at 12 h is predictive of the need for PT and intensive PT. Maximum reticulocytes count is predictive of the severity of ABO incompatibility as evidenced by the need for PRBC transfusions and IVIG therapy.

Preoperative Evaluation of Potential Liver Donor in a Living Donor Liver Transplantation Program in Latin America

Introduction: The living donor liver transplantation (LDLT) technique was developed to face the problem of low-rate donation. Living donor selection is crucial to minimize postoperative donor complications and to improve recipient outcomes This study evaluates the reasons for discarding potential donors in our LDLT program. Methods: Retrospective descriptive analysis from all potential donors evaluated in our LDLT program between April 2018 and July 2021. Selection criteria included age 18-60 years old, no significant medical or mental comorbidities, ABO and anatomical suitability. Results: A total of 231 patients were evaluated. Mean age was 37+11 years and male gender in 52%. 101 potential donors (43.7%) did not complete the evaluation because of the availability of a deceased donor (n=26; 11.3%), ABO incompatibility (n=13; 5.6%), progression or death of the recipient (n=14; 6.1%). Of the 130 who completed their radiological evaluation, the main causes of inadequate candidacy were small liver remnant size (SLRS) (n=17/130; 13.1%) and steatosis (n=15/130; 11.5%). Out of the 231 potential donors, 75 were accepted as adequate donors (32.4%) and 32 candidates underwent liver donation (13.8%). Conclusions: 43.7% of the potential donors didn’t complete the evaluation because of progression, death or deceased donor transplantation of the recipient. Steatosis, SRLS and anatomical variation are the main causes for dropout. Only 1/3 of potential donors are suitable for donation and half of them will undergo surgery. It is important to know main exclusion criteria met by potential donors, in order to make a more efficient use of time and financial resources.

Paired exchange Living Donor Liver Transplantation: A Nine-Year Experience from North India

Introduction: Liver paired exchange donation (LPD) or swap transplantation is an evolving strategy to overcome ABO incompatibility and other barriers like small for size syndrome that confront patients with end-stage Liver disease undergoing Living donor liver transplantation (LDLT). At the same time, for the transplant team to carry out 4 major operations simultaneously is a Herculean effort. Herein, we analyze our experience with LPD program over the past 9 years. Methods: This prospective study includes a total of 2340 LDLTs performed from May 2012 to April 2021. We started the Paired exchange LDLT program in May 2012. LPDs constituted approximately 1.45% (34 of 2340) of the total LDLT procedures. The reasons for LPD were ABO incompatibility in all (n=34) patients. The first and second recipient of each swap pair were divided into R1 and R2 groups for comparative analysis. Results: All patients included in paired exchange LDLT program were Indian citizens and donors were “near” relatives. After donor reassignment through 2-by-2 paired exchange with directed donors, the ABO matching status changed to A to A (n=17) and B to B (n=17) and this made all matches ABO-identical. Donor survival was 100%. The recipient’s (n=34, age 45.5 [11 -59] years; 31 men), UNOS status were 2b (n=5) and C (n=29) and they all underwent elective LDLT surgery with 4 OTs running simultaneously on the same day. The baseline clinical, peri-operative parameters, post-operative complications, median ICU/hospital stay, early deaths were comparable (P>0.1) between the R1 and R2 groups (Table 1). The overall recipient survival was 85.3 % (n=29) over the median follow up period of 20 (0-108) months. Conclusion: Our experience suggests that with careful attention to ethical and logistical issues, LPD program can expand the living donor liver pool and can facilitate a greater number of LDLTs. Keywords: Donor Exchange, Swap Liver Transplantation, Living Donor Liver Transplantation; ABO incompatibilityTable 1Comparative data between R1 and R2 groups of swap liver transplant recipients (n = 34).Parameters (Mean±SD)R1 (n=17)R2 (n=17)P valueAge (years)44.0 (±10.1)47.0 (±5.3)0.296MELD score21.8 (±11.1)19.4 (±6.3)0.445CTP score9.5 (±2.3)10.3 (±2.1)0.294Graft weight (grams)711 (±141.2)796 (±119.8)0.067GRWR1.01 (±0.34)1.18 (±0.26)0.136Warm ischemia time (minutes)32.7 (±7.8)36.1 (±7.1)0.257Cold ischemia time (minutes)109.7 (±61.2)112.6 (±40.9)0.870ICU stay (days)12.4 (±4.6)14.4 (±10.5)0.654Hospital stays (days)16.7 (±4.6)21.6 (±4.7)0.197Complications n (%)Bleeding01 (5.9%)1.00Bile leak02 (11.8%)0.485Acute rejection1 (5.9 %)1 (5.9 %)1.00Hepatic artery thrombosis01(5.9%)1.00Hepatic vein thrombosis2 (11.8%)1(5.9%)0.542Sepsis2 (11.8%)5 (29.4%)0.398Early mortality (Within 1 month)1 (5.8%)3(17.6%)0.6011 year survival16 (100 %)13 (92.8%)0.335Median follow up in months (IQR)27 (8-39)27 (8-43)1.00CTP, Child-Turcot-Pugh; GRWR, graft to recipient weight ratio; ICU, intensive care unit; IQR, inter quartile range; MELD, model for end stage liver disease. Open table in a new tab CTP, Child-Turcot-Pugh; GRWR, graft to recipient weight ratio; ICU, intensive care unit; IQR, inter quartile range; MELD, model for end stage liver disease.

Icterícia neonatal: fatores associados à necessidade de fototerapia em alojamento conjunto

OBJECTIVE: To investigate the frequency of neonatal jaundice and use of phototherapy. To identify risk factors associated with phototherapy in rooming-in care (RC). METHODS: Retrospective study with newborns = 35 weeks in a Tertiary Hospital RC from October to December 2017. Newborns were divided into two groups: treated and untreated for jaundice. Included: inborn neonates without congenital anomalies. Newborns who were admitted in a neonatal ward were excluded. Maternal, gestational, neonatal clinical data and care practices were evaluated. Outcome: use of phototherapy. Associations between groups were assessed using the Students t-test for continuous variables and chi-square for categorical ones. Multiple logistic regression was used to identify independent risk factors associated with phototherapy. RESULTS: 376 newborns were included. 176 newborns (47%) were diagnosed with neonatal jaundice and 66 newborns (18%) were treated with phototherapy. Treated group had lower gestational age (38 x 39 weeks), higher level of bilirubin in umbilical cord blood (2 x 1.5mg/dL), greater weight loss (7 x 6%), more frequent ABO incompatibility (35 x 10%) and prolonged length of hospital stay (79 x 50 hours). Logistic regression identified as independent risk factors for phototherapy: gestational age (OR=6); umbilical cord bilirubin (OR=16); ABO incompatibility (OR=12) and weight loss (OR=1.24). CONCLUSION: Neonatal jaundice was frequent in RC and almost 20% of the newborns were treated with phototherapy. Weight loss was the only preventable risk factor for phototherapy and no protective factor was found.

Hemolitička bolest novorođenčeta

Introduction/Aim: Haemolytic disease of the newborn is haemolytic anaemia that occurs as a consequence of mismatched blood of the parents, that is, the mismatch of blood elements between the mother and fetus in the ABO or Rh system. The aim of this study is to report a case of haemolytic disease of the newborn which occurred as a result of ABO incompatibility. Case report: Indirect hyperbilirubinemia was registered in a female newborn in the 18th hour of life. The blood group of the newborn was A Rh (D) positive, the direct Coombs test was positive and anti-A antibodies were detected in baby's blood. This case was successfully managed with phototherapy and simple red blood cells transfusion without the need for exchange transfusion. Conclusion: ABO incompatibility can be a major problem in the prenatal, perinatal or neonatal periods. Special attention should be paid to pregnant women whose children from previous pregnancies had hyperbilirubinemia or whose pregnancies were ended in miscarriage.