Alloimmunization Against RBC Antigens Is Not Associated With Decreased Survival in Liver Transplant Recipients

Background Improvement of liver transplantation (LT) outcomes requires better understanding of factors affecting survival. The presence of RBC alloantibodies (RBCAs) on survival in LT recipients was evaluated. Methods This study was a single-center, retrospective cohort study reviewing transfusion records and all-cause mortality between 2002 and 2021. Results Between 2002 and 2021, 2079 LTs were completed, 1,396 of which met inclusion criteria (1,305 RBCA negative; 91 RBCA positive [6.5%]). The cohorts were similar in age (mean [range], 55.8 [17-79] years vs 56.8 [25-73] years; P = .41, respectively) or sex (RBCA negative, 859 [65%] men and 446 [35%] women vs RBCA positive, 51 [56%] men and 40 [44%] women; P = .0684). Of 132 RBCAs detected, 10 were most common were to E (27.27%), Jk(a) (15.91%), K (9.09%), C (8.33%), M (6.06%), D (5.3%), Fy(a) (4.55%), e (2.27%), c (2.27%), and Jk(b) (2.27%). Twenty-seven patients (29.7%) had more than 1 RBCA; the most common combinations were C with Jk(a) (7.4%) and E with Di(a) (7.4%). All-cause mortality was increased in men (men, 14.45 years vs women, 17.27 years; P = .0266) and patients 65 years of age and older (>= 65 years of age, 10.21 years vs <64 years of age, 17.22 years; P < .0001). The presence of RBCA (>= 1) did not affect all-cause mortality (RBCA negative, 14.17 years vs RBCA positive, 15.29 years; P = .4367). The top 5 causes of death were infection (11.9%), primary malignancy (solid) (10.8%), recurrent malignancy (10.5%), cardiovascular arrest (7.1%), and pulmonary insufficiency/respiratory failure (5.7%). Conclusions Survival in RBCA-positive LT recipients is no different from that in RBCA-negative LT recipients.