BLOOD-TRANSFUSIONS IN LIVER RECIPIENTS - A CONUNDRUM OR A CLEAR BENEFIT IN THE CYCLOSPORINE TACROLIMUS ERA/

Blood transfusions are common in patients with end-stage liver disease (ESLD), and their effects on sensitization, rejection, and liver graf t survival are not well known. These effects were examined in 121 reci pients of primary liver grafts, surviving greater than or equal to 30 days. Ninety-six (79%) patients received transfusions before transplan tation. Transfusion recipients had significantly fewer severe or recur rent rejection episodes (18%), compared with patients who did not rece ive transfusions (42%, P=0.006), if the first transfusion was greater than or equal to 90 days before the transplant. Patients with alcoholi c ESLD (n=49) had significantly fewer severe rejection episodes when c ompared with the nonalcoholic (n=72) patients (12% vs. 35%, P=0.004). The transfusion benefit was, however, more apparent and significant in the nonalcoholic (26% vs. 56% in nontransfused, P=0.02) than among th e alcoholic recipients (6% vs. 25%, P=0.1). This finding is, most like ly, due to a combination of a higher rate of severe rejection and the statistical power of the larger number of recipients in the nonalcohol ic group. This finding is further corroborated by a multivariate analy sis in which blood transfusions retained their benefit (P<0.05) indepe ndent of recipient's age and diagnosis. Graft and patient survival wer e not significantly different in the transfused versus nontransfused g roups. Transfusion recipients had a higher panel antibody (11.4+/-23.4 vs. 2.7+/-8.1, P<0.02) but no increased risk of a positive crossmatch . In liver recipients, blood transfusions diminish the risk of rejecti on independent of recipient's age and the cause of ESLD.