Transplant recipient’s present unique challenges not only because of product availability but also because of specialized blood components, serologic problems, and immunologic effects of transfusion on the allograft and the recipient. (1).
Liver transplant procedures require the most blood components, despite the fact that blood use in liver transplantation has declined dramatically over the last decade. Whilst the procedure carries the risk of massive blood loss, which requires massive transfusions there are now cases reported without transfusion of product or where the blood loss is limited to 1.5 to 3 litres
The most significant changes have been with kidney transplants across the ABO barrier. ABO mismatch had been avoided due to the acute hyper rejection of the kidney. The change has been due to a better understanding of related immunological mechanisms and the effective various regimens for controlling it. The only other organ where ABO is not crossed is for hearts and livers are felt to be resistant to hyper acute rejection.
Transfusion support has always been part of solid organ transplantation with specialised components needed including CMV negative products, leucoreduced components long before universal leucoreduction was in place. At one time white cells in the products were thought to be beneficial in inducing tolerance and prolonging allograft survival for kidney transplants (2).
The laboratory is involved more than ever with challenges not only because of product availability but also because of specialized blood components, serologic problems, and immunologic effects of transfusion on the allograft and the recipient.
1. Curr Opin Hematol. 2002 Nov;9(6):527-32 Triulzi
2. Topics in Medicine ANZSBT February 2002 Vol 9, No 1