PMID- 32543385
OWN - NLM
STAT- MEDLINE
DCOM- 20201126
LR  - 20201126
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 255
DP  - 2020 Nov
TI  - Human Leukocyte Antigen Class I Antibodies and Response to Platelet Transfusion 
      in Patients Undergoing Liver Transplantation.
PG  - 99-105
LID - S0022-4804(20)30302-4 [pii]
LID - 10.1016/j.jss.2020.05.029 [doi]
AB  - BACKGROUND: Patients undergoing liver transplantation (LT) frequently receive 
      platelet transfusion (PLT) to minimize their risk of hemorrhage. Alloimmunization 
      to platelets may lead to refractoriness to PLT. Data on the implications of 
      platelet alloimmunization in patients undergoing LT remain limited. We examined 
      the effect of human leukocyte antigen class I (HLA-I) antibodies on PLT 
      refractoriness and short-term outcomes after LT. METHODS: Peritransplant clinical 
      and PLT factors were reviewed for all adult liver or simultaneous liver-kidney 
      transplantations from 2012 to 2017. Sensitized patients (SE) with pretransplant 
      HLA-I calculated panel-reactive antibody >/=20% were compared with unsensitized 
      patients (US) with calculated panel-reactive antibody <20%. The mean follow-up 
      was 21.4 mo. RESULTS: Alloimmunization was observed in 39% of the study cohort. 
      SE (n = 28) received 272 PLTs, and US (n = 44) received 246 PLTs. History of 
      pregnancy was higher among SE than US (P < 0.01); otherwise, both groups had 
      similar clinical characteristics. SE had higher rates of PLT refractoriness (66% 
      versus 47%; P < 0.01) than US. The mean platelet corrected count increment was 
      lower among SE compared with US up to 100 min after PLT (P < 0.05). 
      Alloimmunization and simultaneous liver-kidney transplantation independently 
      predicted refractoriness on multivariate logistic regression (P < 0.05). Early 
      allograft rejection and patient survival rates were comparable for both groups. 
      CONCLUSIONS: LT patients experienced high rates of HLA-I alloimmunization and PLT 
      refractoriness. SE had higher rates of refractoriness and lower mean corrected 
      count increment after transfusion compared with US. Our study suggests that 
      further research to evaluate the utility of HLA-matched PLTs in HLA-I 
      alloimmunized LT patients is warranted.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Wong, Melissa
AU  - Wong M
AD  - Division of Transplant Surgery, Department of Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical 
      College of Wisconsin, Milwaukee, Wisconsin.
FAU - Narra, Ravi
AU  - Narra R
AD  - Division of Hematology and Oncology, Department of Medicine, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
FAU - Selim, Motaz
AU  - Selim M
AD  - Division of Transplant Surgery, Department of Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical 
      College of Wisconsin, Milwaukee, Wisconsin.
FAU - Zimmerman, Michael A
AU  - Zimmerman MA
AD  - Division of Transplant Surgery, Department of Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical 
      College of Wisconsin, Milwaukee, Wisconsin.
FAU - Kim, Joohyun
AU  - Kim J
AD  - Division of Transplant Surgery, Department of Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical 
      College of Wisconsin, Milwaukee, Wisconsin.
FAU - Padmanabhan, Anand
AU  - Padmanabhan A
AD  - Division of Hematology and Oncology, Department of Medicine, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; Versiti BloodCenter of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Hong, Johnny C
AU  - Hong JC
AD  - Division of Transplant Surgery, Department of Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin; The Transplant Center, Froedtert and the Medical 
      College of Wisconsin, Milwaukee, Wisconsin. Electronic address: jhong@mcw.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200616
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Blood Loss, Surgical/prevention & control
MH  - End Stage Liver Disease/blood/complications/surgery
MH  - Female
MH  - HLA Antigens/blood/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Isoantibodies/blood/*immunology
MH  - Liver Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Platelet Transfusion/*adverse effects
MH  - Postoperative Hemorrhage/etiology/prevention & control
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Thrombocytopenia/blood/etiology/*therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Alloimmunization
OT  - Cirrhosis
OT  - Human leukocyte antigen class I (HLA-I)
OT  - Liver transplantation
OT  - Platelet refractoriness
OT  - Platelet transfusion
EDAT- 2020/06/17 06:00
MHDA- 2020/11/27 06:00
CRDT- 2020/06/17 06:00
PHST- 2019/11/23 00:00 [received]
PHST- 2020/05/07 00:00 [revised]
PHST- 2020/05/10 00:00 [accepted]
PHST- 2020/06/17 06:00 [pubmed]
PHST- 2020/11/27 06:00 [medline]
PHST- 2020/06/17 06:00 [entrez]
AID - S0022-4804(20)30302-4 [pii]
AID - 10.1016/j.jss.2020.05.029 [doi]
PST - ppublish
SO  - J Surg Res. 2020 Nov;255:99-105. doi: 10.1016/j.jss.2020.05.029. Epub 2020 Jun 
      16.