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Intraoperative blood transfusions in highly alloimmunized patients undergoing orthotopic liver transplantation.

Weber, T and Marino, IR and Kang, YG and Esquivel, CD and Starzl, TE and Duquesnoy, RJ (1989) Intraoperative blood transfusions in highly alloimmunized patients undergoing orthotopic liver transplantation. Transplantation, 47 (5). 797 - 801. ISSN 0041-1337

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Abstract

Intraoperative blood requirements were analyzed in patients undergoing primary orthotopic liver transplantation and divided into two groups on the basis of panel reactive antibody of pretransplant serum measured by lymphocytotoxicity testing. One group of highly sensitized patients (n = 25) had PRA values of over 70% and the second group of patients (n = 26) had 0% PRA values and were considered nonsensitized. During the transplant procedure, the 70% PRA group received considerably greater quantities of blood products than the 0% PRA group--namely, red blood cells: 21.1 +/- 3.7 vs. 9.8 +/- 0.8 units (P = 0.002), and platelets: 17.7 +/- 3.2 vs. 7.5 +/- 1.5 units (P = 0.003). Similar differences were observed for fresh frozen plasma and cryoprecipitate. Despite the larger infusion of platelets, the blood platelet counts in the 70% PRA group were lower postoperatively than preoperatively. Twenty patients in the 70% PRA group received platelet transfusions, and their mean platelet count dropped from 95,050 +/- 11,537 preoperatively to 67,750 +/- 8,228 postoperatively (P = 0.028). In contrast, nearly identical preoperative (84,058 +/- 17,297) and postoperative (85,647 +/- 12,445) platelet counts were observed in the 17 0% PRA patients who were transfused intraoperatively with platelets. Prothrombin time, activated partial thromboplastin time, and fibrinogen levels showed no significant differences between both groups. These data demonstrate that lymphocytotoxic antibody screening of liver transplant candidates is useful in identifying patients with increased risk of bleeding problems and who will require large quantities of blood during the transplant operation.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Weber, T
Marino, IR
Kang, YG
Esquivel, CD
Starzl, TEtes11@pitt.eduTES11
Duquesnoy, RJ
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: May 1989
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 47
Number: 5
Page Range: 797 - 801
Institution: University of Pittsburgh
Refereed: Yes
Uncontrolled Keywords: Adult, Blood Transfusion, Female, HLA Antigens, Humans, Immunization, Intraoperative Period, Liver Transplantation, Lymphocytes, Male, Middle Aged, Platelet Count
ISSN: 0041-1337
Funders: NIDDK NIH HHS (R01 DK029961-19), NIADDK NIH HHS (AM-29961), NHLBI NIH HHS (HL-35069)
Other ID: uls-drl:31735062128768, Starzl CV No. 948
Date Deposited: 08 Apr 2010 17:16
Last Modified: 13 Oct 2017 21:57
URI: http://d-scholarship.pitt.edu/id/eprint/4334

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