{
  "abstract": "Aims Formation of red blood cell alloantibodies (RBCAs) complicates transfusion support in liver transplantation (LT). Difficult RBCAs (DAs, >3 antibodies or antibodies for which <25% donors are antigen negative) further challenge care. This study characterises DA outcomes relative to non-difficult RBCAs (NDAs).Methods Single-centre, retrospective analysis of LT patients (2002–2021). RBCAs were defined as clinically significant antibodies. DAs were compared with NDAs.Results 89 patients had clinically significant RBCAs (DA=50, NDA=39). More DAs were anti-Jka, anti-M; fewer were anti-E, anti-K (all p<0.05). DA patients often had multiple antibodies (44% vs 12.8% NDA, p=0.0022). Probability of finding antigen-negative blood was lower for DAs (17.4% vs 68.1% NDA, p<0.0001) as was RBCs received (9.4 vs 14.7 units in NDA, p=0.0036). Although survival was similar, patients with DAs had more adverse reactions (8% vs 0%, p=0.128). Some antibodies appeared to occur with specific liver diseases (such as primary sclerosing cholangitis, alcoholic steatohepatitis and recurrent disease); however, due to low sample size, definitive conclusions cannot be made.Conclusions DA LT recipients contain >1 RBCA, have a lower probability of finding antigen negative blood and may experience more adverse transfusion event (ATE). Despite this, the incidence of ATEs was still quite low.",
  "authors": [
    {
      "affiliations": [
        "Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Yevgen Chornenkyy"
    },
    {
      "affiliations": [
        "Department of Pathology and Immunology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA"
      ],
      "name": "Margaret Catherine Fink"
    },
    {
      "affiliations": [
        "Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Christopher Felicelli"
    },
    {
      "affiliations": [
        "Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Sean R Stowell"
    },
    {
      "affiliations": [
        "Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Glenn Eugene Ramsey"
    },
    {
      "affiliations": [
        "Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Guang-Yu Yang"
    }
  ],
  "title": "Characterising the challenges of managing difficult red blood cell alloantibodies in liver transplant recipients",
  "uid": "45aa7407-b8f6-5fb5-a1c6-357ce0d341f1"
}