CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / Liver transplant (LT) anemia is multifactorial. Immune hemolysis occurs due to auto-antibodies, drug induced or not, or due to allo-antibodies, formed by transfusion or passenger lymphocyte syndrome (PLS). The aim of this study was to evaluate the prevalence and risk factors for immune hemolysis in LT. Between September 2014 and April 2016, 175 patients submitted to 178 LT were included. Multi-organ recipients were excluded. Samples from before, seven consecutive days and weekly for four weeks were analyzed for complete blood cound, reticulocyte count, lactate dehydrogenase (LDH), indirect bilirrubin (IB) and imummohematological tests. SPSS 24 was used for statistical analysis, p<0.05 was considered significant. The mean age was 52.1  14.6 years old, with 105 male patients (60%). The most frequent causes of cirrhosis were hepatitis C virus (HCV, 59 â 33.7%) and alcohol (44 â 25.1%). Anemia before LT was present in 140 patients (74.2%), with lower hemoglobin (Hb) concentration in those with positive direct antiglobulin test (DAT, p=0.014). Nine patients (5.1%) presented positive antibody screen (AS) before transplant, with 2.3% of clinical significance. This finding was more frequent in RhD negative patients (p=0.017). Positive DAT occurred in 53 patients (30.3%) and was related to high MELD score (p=0,048), HCV (p=0.005) and furosemide use (p=0.001). These patients presented higher levels of IB (p<0.001). Ninety six patients (55%) were transfused in the studied period. One hundred and fourty five patients (87.8%) were still anemic on the fourth week. Twenty two patients (12.5%) presented positive AS after LT, with nine patients (5.7%) presenting clinically significant antibodies. Positive AS occurred more frequently in RhD negative (p=0.021) and in those transfused with red blood cells units (RBCU, p=0.022). Sixteen patients received grafts with minor ABO incompatibility. Post-transplant positive DAT was associated with higher levels of LDH (p=0.006), piperacillin-tazobactam use (p=0.021) and was more frequent in the non identical ABO group (p=0.0038). In this group, five of eleven positive DAT patients presented anti-A (2) or anti-B (3) on the eluate, representing PLS. All PLS patients received liver graft O and were using mycofenolate, tacrolimus and steroids. Four patients presented hemolysis and three were transfused due to PLS. These patients, compared to all the other patients, presented lower Hb concentration (p=0.043) and higher LDH levels (p=0.008) and reticulocyte counts (p=0.008). The presence of auto and allo-antibodies against red blood cell antigens is frequent in LT, but clinical significant hemolysis occurred in only 2.8%. Antibodies are more frequent in patients with higher MELD scores, with HCV, in use of pre-transplant furosemide, in those transfused patients with RBCU, RhD negative and piperacillin-tazobactam use after LT. The only risk factor for PLS is minor ABO mismatch between donor and recipient. / Anemia no transplante hepÃtico (TH) à multifatorial. HemÃlise imune ocorre por autoanticorpos, com ou sem relaÃÃo com drogas, ou aloanticorpos, formados por transfusÃo ou sÃndrome do linfÃcito passageiro (SLP). O objetivo deste estudo foi avaliar a prevalÃncia e fatores de risco para hemÃlise imune no TH. Foram incluÃdos, entre setembro de 2014 e abril de 2016,175 pacientes submetidos a 178 TH, sendo excluÃdos transplantes de mÃltiplos ÃrgÃos. Amostras prÃ-TH, de 7 dias consecutivos e semanalmente atà 4 semanas foram avaliadas com hemograma, reticulÃcitos, lactato desidrogenase (LDH), bilirrubina indireta (BI) e testes imuno-hematolÃgicos. SPSS 24 foi usado para estatÃstica, com p<0,05 significante. A idade mÃdia foi de 52,1  14,6 anos, com 105 homens (60%). As etiologias mais frequentes da cirrose foram vÃrus da hepatite C (VHC, 59 - 33,7%) e Ãlcool (44 - 25,1%). Anemia prÃ-transplante estava presente em 140 pacientes (74,2%), com menores concentraÃÃes de hemoglobina (Hb) naqueles com teste direto da antiglobulina (TAD) positivo (p=0,014). Nove pacientes (5,1%) apresentaram pesquisa de anticorpos irregulares (PAI) positiva prÃ-TH, sendo 2,3% clinicamente significantes. Esse achado foi mais frequente em RhD negativo (p=0,017). TAD positivo prÃ-TH ocorreu em 53 pacientes (30,3%), com relaÃÃo com escore MELD elevado (p=0,048), VHC (p=0,005) e uso de furosemida (p=0,001). Esses pacientes apresentaram BI mais elevada (p<0,001). Noventa e seis pacientes (55%) receberam hemocomponentes no perÃodo estudo. Cento e quarenta e cinco pacientes (87,8%) ainda estavam anÃmicos na 4a semana. Vinte e dois pacientes (12,5%) apresentaram PAI positiva pÃs-TH, sendo nove pacientes (5,7%) com anticorpos clinicamente significantes. PAI positiva foi mais frequente em RhD negativo (p=0,021) e nos transfundidos com concentrado de hemÃcias (CH - p=0,022). Dezesseis pacientes receberam enxerto ABO nÃo idÃntico. TAD positivo pÃs-TH esteve associado a aumento de LDH (p=0,006), uso de piperacilina-tazobactam (p=0,021) e foi mais frequente no grupo ABO nÃo idÃntico (p=0,0038). Nesse grupo, cinco dos 11 com TAD positivo apresentaram eluato com anti-A (02) ou anti-B (03), configurando SLP. Todos receberam fÃgado O e estavam em uso de micofenolato, tacrolimus e corticoide. Quatro apresentaram hemÃlise e trÃs foram transfundidos pela SLP. Esses pacientes, quando comparados aos demais, apresentaram Hb menor (p=0,043) e LDH (p=0,008) e reticulÃcitos (p=0,008) maiores. A presenÃa de auto e aloanticorpos contra antÃgenos eritrocitÃrios à frequente no TH, porÃm hemÃlise clinicamente manifesta ocorreu em apenas 2,8%. A presenÃa de anticorpos à mais frequente em pacientes com escore MELD mais elevado, com VHC, que utilizam furosemida prÃ-transplante, naqueles transfundidos com CH, RhD negativo e que utilizam piperacilina-tazobactam pÃs-transplante. O Ãnico fator de risco para o desenvolvimento de SLP encontrado à a incompatibilidade ABO menor entre doador e receptor.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:12136 |
| Date | 09 December 2016 |
| Creators | Denise Menezes Brunetta |
| Contributors | Josà Huygens Parente Garcia, Gustavo Rego Coelho, Maria da Silva Pitombeira, Claudia Maria Costa de Oliveira, Gil Cunha de Santis |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Cirurgia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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