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.