Journal Article Successful Blood Transfusion Management of a Living Donor Liver Transplant Recipient in the Presence of Anti-Jrª: A Case Report

Kurata, Nobuhiko  ,  Onishi, Yasuharu  ,  Kamei, Hideya  ,  Hori, Tomohide  ,  Komagome, Masahiko  ,  Kato, Chiaki  ,  Matsushita, Tadashi  ,  Ogura, Yasuhiro

49 ( 7 )  , pp.1604 - 1607 , 2017-09 , Elsevier
A 48-year-old Japanese woman was diagnosed with Budd-Chiari syndrome and transferredfor possible living donor liver transplantation (LDLT). Examinations before LDLTrevealed that the recipient had anti-Jrª and preformed donor-specific antiehuman leukocyteantigen (HLA) antibodies (DSA). Rituximab was administrated at 16 days prior to thepatient’s scheduled LDLT for the prophylaxis of antibody-mediated rejection by DSA. Theclinical significance of anti-Jrª has not been clearly established because of the rarity of thisantibody, so we discussed blood transfusion strategy with the Department of BloodTransfusion Service and prepared for Jrª-negative packed red blood cells (RBCs). Intraoperativeblood salvage was used during LDLT procedures to reduce the use of packedRBCs. Although post-transplantation graft function was excellent, a total of 44 U ofJrª-negative RBCs were transfused during the entire perioperative period. Because suffi-cient amounts of Jrª-negative packed RBCs were supplied, Jrª mismatched blood transfusionwas avoided. The patient was discharged from our hospital on postoperativeday 102 without clinical evidence of any blood transfusionerelated adverse events.Although there are some controversies of blood transfusion related to anti- Jrª antibodies,the current strategies of blood transfusion for liver transplantation with anti-Jrª are asfollows: (1) sufficient supply and transfusion of Jrª-negative matched packed RBCs and(2) application of intraoperative blood salvage to reduce the total amount of rare bloodtype RBCs. These strategies may be changed when the mechanism of anti-Jrª alloimmunizationis fully understood in the future.

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