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ABO blood group antigens are critical determinants of immunologic self and non-self and are ubiquitously expressed on all cellular tissues. Antibodies against non-self ABO antigens are naturally present and can mediate pathologic reactions against incompatible transfused blood cells and transplanted tissues. Laboratory testing for ABO antigens and isoagglutinins is essential for safe and effective transfusion and transplantation. Testing for ABO antigens has traditionally depended on serologic testing. However, there is increasing need for evaluation of genetic analysis of ABO antigens, to enable evaluation of ABO blood group in cases where serologic testing may be ambiguous or impossible to accurately perform. The clinical need for ABO genotyping is being addressed by the development of multiple molecular diagnostic approaches. Recent data have clearly demonstrated the potential utility of ABO genotyping in solid organ transplantation, yet widespread implementation has been slow. We propose that this lag is related to practical considerations in laboratory testing, including limited regulatory guidance on the performance and reporting of these assays and the absence of widely available external proficiency testing programs for quality assurance. Here we describe approaches to ABO genotyping, current initiatives in developing ABO genotyping proficiency testing programs, and laboratory quality assurance considerations for ABO genotyping.

The letter published in the Blood Cancer Journal discusses the use of luspatercept for treating anemia in patients who have undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT). The study involved 16 patients with various hematological diseases, with 81.3% achieving an erythroid response after luspatercept treatment. The treatment was generally well-tolerated, with mild adverse events reported. The study suggests that luspatercept could be an effective option for managing anemia post-allo-HSCT, although further research is needed due to the study's limitations. [Extracted from the article]

Purpose: This study assessed whether or not the ABO blood type affects the incidence of HCC recurrence after living donor liver transplantation (LDLT). Methods: This retrospective observational study included 856 patients with hepatocellular carcinoma (HCC) who underwent LDLT between January 2006 and December 2016 at the Asan Medical Center. Results: This study included 324 patients (37.9%) with blood type A, 215 (25.1%) with blood type B, 210 (24.5%) with blood type O, and 107 (12.5%) with blood type AB. ABO-incompatible LT was performed in 136 (15.9%) patients. The independent risk factors for the disease-free survival (DFS) were maximal tumor diameter, microvascular invasion, and Milan criteria. The only independent risk factor for the overall survival (OS) was microvascular invasion. The ABO blood group did not affect the DFS (P = 0.978) or OS (P = 0.261). The DFS according to the ABO blood group did not differ significantly between the ABO-compatible (p = 0.701) and ABO-incompatible LDLT recipients (p = 0.147). The DFS according to the ABO blood group did not differ significantly between patients within the Milan criteria (p = 0.934) and beyond the Milan criteria (p = 0.525). The DFS did not differ significantly between recipients with and without type A blood (p = 0.941). Conclusions: This study demonstrated that the ABO blood group system had no prognostic impact on the oncological outcomes of patients undergoing LT for HCC. [ABSTRACT FROM AUTHOR]

Background: ABO-incompatible kidney transplantation (ABOi-KTx) represents a possible solution to address the shortage of kidney donors. However, these transplants present immunological challenges, particularly when isoagglutinin titers are elevated pretransplant. Methods: Single-center retrospective study describing clinical and biological outcomes of 8 patients who underwent ABOi-KTx with initial isoagglutinin titers ≥ 1/512. All patients followed a desensitization protocol combining immunosuppression (rituximab, tacrolimus, mycophenolate mofetil, steroids), and specific or semi-specific apheresis sessions. Clinical and biological data were extracted from electronic medical records. Results: There were 5 males; median age of 62 years [34-82 years]; all achieved an isoagglutinin titer of ≤1/8 before transplantation after a median of 13 (range: 9-15) apheresis sessions. Three patients (37%) experienced acute humoral rejection, which required additional plasmapheresis sessions. Two patients developed chronic active rejection, successfully treated. On the infectious side, three patients developed BK-virus reactivation. Two patients developed cytomegalovirus viremia, and two others presented with bacterial infections. Surgically, two patients developed a lymphocele, and one had a perirenal hematoma. All patients survived the transplant with stable renal function: mean serum creatinine was 138 ± 15 µmol/L after four years of follow-up. Conclusion: ABO-incompatible kidney transplantation, even in patients with high isoagglutinin titers, is feasible and can achieve favorable long-term graft and patient survival outcomes. However, these procedures require substantial clinical expertise and close follow-up to monitor and manage the elevated risks of infection and rejection in this population. [ABSTRACT FROM AUTHOR]

Kidney retransplantations are associated with an increased risk of rejection and reduced graft survival compared to first transplantations, notably due to HLA sensitization. The impact of repeated eplet mismatches on retransplantation outcome has not been investigated. We retrospectively assessed the risk of antibody-mediated rejection (ABMR) and graft loss associated with preformed DSA targeting Repeated Eplet MisMatches (DREMM) in sensitized patients undergoing kidney retransplantation. We included 45 retransplanted patients with preformed DSA against the second donor. We determined HLA incompatibilities at the eplet levels, and the eplet target of the DSA using HLAMatchmaker®. Repeated mismatches were more frequent at the eplet (87%) than at the antigenic level (22%), but were not associated with the risk of ABMR. The eplet specificity of the DSA revealed that 60% of patients (n = 27) had DREMM. The presence of DREMM was associated with a higher frequency of ABMR (70% versus 28%, P = 0.005) and with a lower death-censored graft survival (log-rank test, P = 0.01). However, in multivariate Cox model, we could not show that DREMM were associated with the risk of ABMR. In conclusion, this study suggests that identifying DREMM may be an interesting clinical tool, however further larger studies are necessary to precise their exact predictive value. [ABSTRACT FROM AUTHOR]

Background/Objectives: ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) has become an established treatment for end-stage renal disease. Non-inferiority in the long-term graft function compared to ABO-compatible live-donor kidney transplantations (ABOc-LDKTs) has been shown. However, the assumed burden due to complications owing to increased immunosuppression inherent to ABOi-LDKTs has not yet been quantified. The aim of this study was to determine if ABOi-LDKT recipients suffer from additional morbidity and whether the resulting burden is justified. Methods: We retrospectively analyzed 45 matched pairs of ABOi-LDKTs and ABOc-LDKTs transplanted over a twenty-year period from January 2000 to March 2020. The number and duration of postoperative readmissions, surgical complication rates according to Clavien–Dindo and its comprehensive complication index (CCI), kidney function, occurrence of new-onset diabetes, and infections as well as tumor incidence were analyzed. Results: Patient and graft survival, as well as graft function, were comparable between the two groups. There were no significant differences in terms of complications, readmission rates, and length of readmission, as well as infection and rejection rates. The median CCIs for ABOi-LDKTs and ABOc-LDKTs at primary discharge and 3, 6, 12, and >12 months were 20.9 vs. 20.9 (p = 0.363), 31.4 vs. 33.7 (p = 0.438), 33.7 vs. 33.7 (p = 0.875), 20.9 vs. 33.1 (p = 0.25), and 27.1 vs. 31.9 (p = 0.163), respectively. Conclusions: ABOi-LDKT seems safe, with comparable outcome, complication, and readmission rates to ABOc-LDKT. In recipients with ABOi living donors, transplantation should not be delayed solely due to concerns over increased perioperative risks. [ABSTRACT FROM AUTHOR]

Aim: In India, 85% of organ donations are from living donors and 15% are from deceased donors. One‐third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost‐effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%–35%. Methods: We report our experience with 539 KET cases and the evolution of a single‐centre program to increase the use of LDKT. Results: Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2‐way (n = 2 × 202 = 404), 16.2% 3‐way (n = 3 × 29 = 87), 3% 4‐way (n = 4 × 4 = 16), 1.8% 5‐way (n = 5 × 2 = 10), 2.2% 6‐way (n = 6 × 2 = 12), and 1.8% 10‐way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow‐up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high‐volume LDKT programs, non‐anonymous allocation and teamwork. Conclusion: This is the largest single‐centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs. [ABSTRACT FROM AUTHOR]

ABO group incompatibility at the time of transfusion of blood products carries risks ranging from mild adverse reactions to death of the patient. In modern obstetrics, the leading cause of death is obstetric hemorrhage, for which uterotonics, compression sutures, arterial ligatures, solutions, and blood products are used. For this reason, it is necessary to know the blood group . and Rh of each patient admitted for obstetric surgery and have her sign a consent form for transfusion of blood or blood derivatives, explaining all the adverse effects that may occur in the event of complications. We describe a case of postpartum transfusion with a hemolytic reaction due to ABO incompatibility and its clinical management. [ABSTRACT FROM AUTHOR]

Objective was to assess the effectiveness of exchange transfusion (ET) in managing HDN, with a focus on comparing treatment outcomes between ABO and Rh incompatibility cases. Methods: A study enrolled 125 neonates diagnosed with hyperbilirubinemia, comprising 66 males and 59 females. The gestational age of the neonates ranged from 33 to 41 weeks, and their birth weights varied between 2.11 to 4.3 kilograms. Based on the etiology of hemolysis, the study categorized 73 cases as ABO group and 52 as Rh group. Results: Post- ET, there was a significant reduction in serum total bilirubin (STB), serum indirect bilirubin (SIB), and platelet (PLT) counts (P< 0.001). Pre- ET, differences in SIB and PLT were noted between neonates with ABO and Rh incompatibilities (P< 0.05). There was no statistically significant disparities in the therapeutic effects of ET on STB, SIB, and PLT levels when comparing male and female neonates across both the ABO and Rh incompatibility groups. Conclusion: Our study demonstrated that ET is efficacious in reducing bilirubin levels and platelet counts in neonates presenting with ABO and Rh blood group incompatibilities. Notably, the effectiveness of ET was found to be independent of the neonates' gender, a finding that underscores the universal applicability of this treatment approach. Our study observation contradicts the prevalent belief that HDN associated with the Rh system is inherently more severe than that linked to the ABO system. This revelation underscores the imperative for the swift implementation of ET in managing cases of severe hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Introduction: The Direct Antiglobulin Test (DAT) is a screening technique used to detect Immunoglobulin G (IgG) antierythrocyte antibodies on foetal Red Blood Cells (RBCs). Universal bilirubin screening decreases the incidence of severe hyperbilirubinemia. The diagnostic efficacy of DAT in cases of ABO incompatibility is not well established, in contrast to Rh incompatibility. Aim: To evaluate the diagnostic ability of routine cord blood DAT in neonates ≥35 weeks of gestation with ABO incompatibility in predicting the requirement for phototherapy. Additionally, to compare the diagnostic ability between two methods of DAT estimation, namely the semiagglutination gel method and the conventional tube method. Materials and Methods: This prospective cohort study was conducted from September 2022 to March 2024 at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Following the acquisition of informed consent, cord blood samples were collected from 934 neonates delivered after 35 weeks of completed gestation to mothers with O blood type. In cases of ABO incompatibility (523 neonates), DAT was performed using both the manual tube method and the automated semiagglutination gel method in the blood bank. Serum bilirubin levels, complete blood counts with peripheral smear analysis and reticulocyte counts were performed on day 3 or earlier, as clinically indicated. The neonates were treated in accordance with the American Academy of Paediatrics (AAP) 2004 recommendations on phototherapy. Babies were monitored for jaundice until 14 days of age. Results: Out of 3,092 eligible deliveries, 523 babies with ABO incompatibility were enrolled. The baseline characteristics were comparable. Bilirubin levels in DAT-positive and DAT-negative neonates were 14.60±3.58 mg% and 13.18±3.16 mg% (p-value

Background : ABO-incompatible (ABOi) kidney transplantation poses significant challenges in achieving successful outcomes. This study aimed to investigate the impact of various interventions and techniques on improving the success rates of ABOi kidney transplantation. Methods : We conducted a retrospective observational analysis of patients who underwent ABOi kidney transplantation from November 2012 to March 2023. The study included a total of 105 patients. We collected and analyzed data on patient demographics, preoperative assessments, surgical details, and postoperative outcomes. Results : The mean ages of the donors and recipients were 50.52±10.32 and 36.63±11.61 years, respectively. The majority of recipients were male (81.9%), while most donors were female (89.5%). The most common blood group among recipients was O (69.5%), and among donors, it was B (46.7%). The median durations of chronic kidney disease and dialysis were 12 months (interquartile range [IQR], 7–28 months) and 6 months (IQR, 2–12 months), respectively. Baseline antibody titers (anti-A and anti-B) ranged from 64.0 to 256.0, while on the day of surgery, they were ≤8. Perioperative complications included hypotension (10.5%), acute tubular necrosis (5.7%), delayed graft function (3.8%), and reexploration (3.8%) due to hematoma. Conclusion : s: ABOi kidney transplantation is a viable option for recipients lacking available donors with an ABO-compatible match. Perioperative concerns, including hypoalbuminemia, heightened risk of infections, coagulopathies, aseptic precautions, and immunological surveillance, must be carefully addressed.

Background: Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to conventional open kidney transplantation (OKT). This study investigates the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi). Methods: This retrospective, single-center study included 239 living-donor transplants between October 2020 and February 2023, with 210 patients undergoing ABOi-OKT and 29 undergoing ABOi-RAKT. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies was analyzed through univariate and multivariate models. Propensity score matching (PSM) was utilized to ensure a balanced comparison between the two groups. Following PSM, a total of 131 cases in the OKT group and 26 cases in the RAKT group were analyzed. Results: After PSM, the mean recipient age was 48.56 years for OKT and 47.96 years for RAKT. Both groups had comparable one-year (RAKT: 92.4%, OKT: 93.1%) and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 91.9%). Mean estimated glomerular filtration rate values were similar at 12 months post-transplant (RAKT: 62.15 ml/min/1.73 m², OKT: 64.53 ml/min/1.73 m²). Operative times were significantly longer for RAKT (291.42 vs. 150.81 min, p < 0.001), while cold ischemic time was also longer for RAKT (119.77 vs. 47.22 min, p < 0.001). Hospital stays were shorter for RAKT (median 6 vs. 8 days, p < 0.001). There was no significant difference in the composite outcome of BPAR, graft failure, and de novo donor-specific antibodies between the two groups (HR 0.858, 95% CI: 0.180–4.096, p = 0.848). Conclusions: RAKT is a safe and effective alternative to OKT in ABOi patients, demonstrating similar perioperative outcomes, graft survival rates, and renal function. The application of ropensity score matching analysis strengthens the reliability of these findings, confirming RAKT's viability for high-risk kidney transplant recipients. Trial registration: The clinical trial associated with this study was registered on 2024-02-24 with the Clinical Trial Number NCT06287008||https://www.clinicaltrials.gov/) [ABSTRACT FROM AUTHOR]

Background: Group AB plasma does not contain anti‐A or anti‐B antibodies and is therefore considered universal but is in limited supply (4% of the population). There is currently no licensed universal plasma available, and therefore current clinical guidelines for transfusion require the donor and recipient to be blood group compatible. We sought to understand the benefits of universal plasma to hospitals in England, to inform R&D priorities going forward. Study Design and Methods: To understand the benefits of universal plasma (cryoprecipitate included), we distributed two surveys to hospitals (267 in total) in England. Results: Safety was the perceived top benefit of universal plasma (95%), with cost identified as the main barrier to adoption (82%), although the majority of respondents were willing to pay more for universal components. Ninety‐five respondents felt they would replace all or part of their stock holding with universal plasma, with 91% anticipating that their overall stock holding of plasma would reduce as well as there will be a reduction in their plasma wastage (by up to 25%). Hospitals (56%) thought that the availability of universal plasma would support more rapid provision of plasma for transfusion, particularly in emergency situations, with the emergency/trauma department deemed to be the area that would see the greatest benefit from these universal blood components. Discussion: The response to both the potential clinical and operational benefits of a universal plasma and cryoprecipitate was positive. [ABSTRACT FROM AUTHOR]

The document contains abstracts from the Australian and New Zealand Society of Blood Transfusion (ANZSBT) Stream of the BLOOD 2023 Meeting held in Melbourne, Australia. It includes presentations on topics such as monitoring transfusion and patient safety risks, characterizing the Kidd blood group system in a Kenyan population, and applying Massively Parallel Sequencing (MPS) technology for non-invasive prenatal testing to detect red cell and platelet antigens. The research presented aims to improve transfusion practices, understand blood group distribution patterns, and enhance patient outcomes in transfusion. [Extracted from the article]

Introduction: ABO blood type changes after ABO-incompatible hematopoietic stem cell transplantation (HSCT). Most non-hematopoietic tissues retain the expression of the patient's own ABO antigens, which may adsorb from the plasma onto the donor's red blood cells (RBCs). Because of this phenomenon, a persistent patient's A and/or B antigen could be detected in the laboratory, despite 100% white cell donor chimerism. Adsorption of the patient's soluble ABO antigens on the newly formed RBCs complicates the interpretation of the patient's blood type and decision of transfusion therapy. Case Presentation: The first case report is a 6-year-old girl, A, D+, with T-cell acute lymphoblastic leukemia (ALL), transplanted with HLA-matched unrelated group O, D+ bone marrow. A second case report describes an 8-year-old girl, AB, D−, with ALL transplanted with an HLA-matched related group B, D+ bone marrow. The presence of persistent antigen A was registered in both patients more than 1 year after HSCT, despite complete donor chimerism. Conclusion: The weak expression of ABO antigens on RBCs after HSCT should be examined in detail for proper planning of transfusion therapies. [ABSTRACT FROM AUTHOR]

Haploidentical haematopoietic stem cell transplantation (haplo‐HSCT) is one of the most effective therapies for treating malignant haematological disorders. However, HLA disparities are significant barriers to the success of this process since they increase the risk of graft versus host disease (GvHD). HLA disparities quantification could help to anticipate the probability and degree of GvHD, but the best tool for such quantification remains a challenge. The aim of this study was to quantify the degree of HLA epitope incompatibilities using PIRCHE (Predicted Indirectly Recognisable HLA Epitopes) algorithm for immunogenicity prediction and their potential relationship with GvHD degree and clinical outcome. We studied 145 patients who underwent a haplo‐HSCT with post‐transplant cyclophosphamide (PTCy) from a related donor between 2013 and 2020 at our centre evaluating molecular HLA mismatches by PIRCHE‐algorithm. Patients with PIRCHE Score (PS) I + II > 38 in GvH direction, developed acute GvHD grade II–IV earlier than their counterparts (HR: 1.71, 95% CI: 1.02–2.87, p = 0.032). In addition, PS‐B > 1 in GvH direction was an independent risk factor for chronic GvHD, (HR: 2.51, 95% CI 1.17–5.36, p = 0.017). A higher incidence of relapse was found for patients with PS‐II > 28 HvG (HR: 9.16, 95% CI: 2.47–33.92, p < 0.001) which also favoured a worse GvHD/relapse‐free survival in patients with PS‐II > 27 in HvG direction (HR: 1.88, 95% CI: 1.11–3.18, p = 0.017). These findings indicate that the alloreactivity inferred by epitope HLA disparities is associated with post‐transplant outcomes. Thus, analysing PS could benefit the selection of the most suitable donors allowing patient stratification based on HLA mismatches in the context of haplo‐HSCT with PTCy. [ABSTRACT FROM AUTHOR]

In ABO blood group incompatible kidney transplantation (ABO-I), potential issues on acute antibody-mediated rejection (ABMR) remain to be solved. This study aimed to assess the risk factors of acute ABMR using recipient- or donor-derived specimens. Quantitative analysis of A/B antigen expression was conducted in 104 donor kidney tissues (Kt), platelets (Plt), and red blood cells (RBC) by immunohistochemical staining or flow cytometry (FCM). ABO-I pre-transplant recipient serum samples (ABMR = 12, non-ABMR = 27) were extracted by propensity score matching. Anti-A antibody titers of IgM, IgG and IgG subclasses, and C1q binding ability (%) on antibody were measured using RBC-FCM. No association was observed between ABMR and A/B antigen expression levels in donor’s Plt, RBC, or Kt. In recipient’s sample, C1q-IgG binding ability was significantly higher in the ABMR group than in the non-ABMR group (C1q−IgG: 9.04% vs. 5.93% p = 0.049). Neither the A/B antigen expression level in donors (grafts) nor anti-blood group IgG/IgM antibodies in recipient sera before desensitization seemed to influence ABMR incidence in ABO-I. In contrast, C1q-IgG binding ability could be a potential predictor for ABMR in ABO-I. [ABSTRACT FROM AUTHOR]

Summary Prevention of ABO‐incompatible red cell transfusions (ABO‐it) requires accurate donor and patient identification and correct application of processes for transfusion safety. In France and Germany, a bedside identity check and ABO compatibility test are performed. In the UK, an identity check, often structured as a bedside checklist, is performed with or without electronic patient identification (ePID). To compare the efficacy of ABO‐it bedside preventive measures, frequencies and causes of ABO‐it between 2013 and 2022 were investigated in all three countries. Despite differing bedside safety measures, similar average ABO‐it frequencies were observed in France (0.19 [SD:0.09]/100 000 issued red cell units) and in the UK (0.28 [SD:0.17]/100 000), whereas a higher frequency (0.71 [SD:0.23]/100 000) was observed in Germany which has similar bedside safety measures to France. ABO‐it resulted mostly from erroneous patient identification and transfusion of a red cell unit intended for another patient. In France and Germany, all ABO‐it were associated with incorrectly performed identity check and ABO compatibility test. In the UK, most ABO‐it were associated with incorrectly performed identity checks. Current measures to prevent ABO‐it are not fully effective. Further development and implementation of effective patient identification systems, including electronic information systems, across the entire transfusion process, should be considered. [ABSTRACT FROM AUTHOR]

Recurrent Pregnancy Loss (RPL) is diagnosed in 3% of all patients of reproductive age and is of high interest to reproductive medicine specialists. Immunological predispositions are among the crucial risk factors for RPL development in female patients suffering from RPL. Therefore, the purpose of this work is to investigate the role and effectiveness of individualised immunological treatment approaches by analysing several clinical cases with diagnosed pregnancy loss and the results of tailored immunological therapies. Based on 25 years of clinical experience and scientific research the paper analysed the relationship between Human Leukocyte Antigens (HLA) tissue compatibility and ABO blood group system incompatibility in immunological pregnancy failure. The connection of these factors was shown in 2 clinical cases suffering from RPL who agreed to participate in research. Research was performed at Nakhchivan Birth Center and Nakhchivan State University. The results of the study provided evidence based on these cases of RPL that ended with successful childbirth after the suggested genetic assessment and immunological treatment. Individual treatment of immunological pregnancy failure with HLA and ABO blood group incompatibilities showed more effective outcomes if compared to previous schemes of treatment. HLA compatibility in loci 3 combined with affinity on the ABO system strongly demanded immunological therapy prescription for successful implantation of the blastocyst. The outcomes obtained from the study can be implemented in obstetrics and gynecology for the improvement of clinical cases suffering from RPL. [ABSTRACT FROM AUTHOR]

Extreme levels of bilirubin in newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. To determine the incidence, aetiology and short-term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. This is a retrospective observational study looking at term neonates with a birth weight ≥2500 g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥430 μmol/L in the first week of life and received care in the public health system. Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 h old (SD 31 h). The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity. [ABSTRACT FROM AUTHOR]

Objectives: ABO hemolytic disease of the newborn (ABO HDN) is the most common cause of neonatal jaundice due to feto-maternal incompatibility. The objective of this study is to evaluate early predictors of ABO HDN using immuno-hematological and biochemical tests. Materials and method: Newborns with blood group A/B born to group O mothers were prospectively enrolled in the present study. Direct antiglobulin test (DAT) and cord blood bilirubin (CBB) were performed. Total serum bilirubin (TSB) was measured at 72 hours of life. Serum anti-A/B IgG titers of maternal samples were measured. For the statistical analysis, Microsoft Excel 2013 (Microsoft Corporation, NY, USA) and SPSS statistical computer software (version 22) were used. To find the efficacy and cut-off values for various predictors of neonatal jaundice, receiver operating characteristic (ROC) curve analysis was performed. To evaluate the relative importance of predictors for phototherapy (PT), logistic regression was used. Results: A total of 200 ABO incompatible mother-neonate pairs were included in the present study. The incidence of ABO HDN was 10% (n=20). The number of DAT positive cases was 38 (19%). Regression analysis showed a significant influence of antibody titre, CBB and DAT on probability of phototherapy. Antibody titers =512 predicted severe hyperbilirubinemia with 80% sensitivity and 83% specificity; CBB = 2.75 mg/dL had 85% sensitivity and 83% specificity. Conclusion: High risk ABO-incompatible neonates could be identified at birth using maternal antibody titers, DAT and CBB. Early diagnosis with enhanced surveillance will help in optimum utilization of healthcare. [ABSTRACT FROM AUTHOR]

ABO incompatibility does not hinder bone marrow transplantation (BMT), but it has been associated with worse outcomes and additional adverse events. This study aimed to verify the impact of incompatible red blood cells (iRBCs) in allogeneic BMT and to determine a safe number of iRBCs to be infused. We compared ABO-incompatible (iABO) allogeneic BMT (n = 42) with ABO-compatible allogeneic BMT (n = 44) and evaluated the impact of the number of infused iRBCs on outcomes and adverse events. The iABO patients demonstrated delayed time to transfusion independence at 30 days and 60 days, increased requirement for red blood cell (RBC) transfusion and greater hemolysis signals and incidence of pure red cell aplasia. Neutrophil/platelet engraftment, length of hospitalization post-transplant, platelet units required, graft-versus-host disease occurrence and overall survival were similar in both groups. Patients in the iABO group received 1.03 × 1010 iRBCs/kg (range, 0.36–3.88). Infusion of iRBCs >1.0 × 1010 /kg was related to graft failure or death before neutrophil engraftment or platelet engraftment or both as well as increased plasma requirement and increased creatinine. Our results also suggest that antibody titers impact the transplantation scenario. The iABO transplantation showed some unfavorable outcomes. It is important to monitor the value of iRBCs to be infused, considering the recipient antibody titers. We propose using the number of iRBCs (iRBCs/kg) as a dose parameter with regard to infused iRBCs. Further studies are necessary to clarify the maximum safe number of iRBCs in iABO transplants. [ABSTRACT FROM AUTHOR]

Introduction: Delayed graft function (DGF) is a common condition that necessitates dialysis during the first week after transplantation. Although DGF rarely occurs following living-donor kidney transplantation (LDKT), it may eventually lead to acute or chronic graft rejection. This study aimed to assess the risk factors for DGF in patients who underwent LDKT. Methods: A systematic review and meta-analysis of studies published before August 2022 was conducted using the PubMed, Science Direct, Cochrane, and Directory of Open Access Journal (DOAJ) databases. The review included studies that assessed the incidence of DGF following LDKT, and examined its risk factors, while excluding studies involving deceased donors. Potential risk factors were analyzed using pooled mean differences or odds ratios with 95% confidence intervals (Cis). Review Manager 5.3 was used for the meta-analysis. Results: Among the 13 included studies, 3685 cases of DGF were identified in a total of 113,261 patients (3.25%). Potential risk factors for DGF following LDKT were examined across several aspects, including donor, recipient, donor/recipient relationship, and immunological and intraoperative factors. The identified risk factors included older donors (P = 0.07), male recipients (P < 0.0001), higher recipient body mass index (BMI) (P < 0.0001), nonwhite recipients (P < 0.0001), pre-existing diabetes (P < 0.0001), pre-existing hypertension (P = 0.01), history of dialysis (P < 0.0001), re-transplantation (P = 0.004), unrelated donor/recipient (P = 0.02), ABO incompatibility (P < 0.0001), higher panel reactive antibody (PRA) levels (P < 0.0001), utilization of right kidney (P < 0.0001), and longer cold ischemia time (CIT) (P = 0.004). Conclusion: Several factors related to the donor, recipient, donor/recipient relationship, and immunological and intraoperative aspects were identified as potential risk factors for the development of DGF following LDKT. Addressing and optimizing these factors may improve the long-term outcomes of LDKT. [ABSTRACT FROM AUTHOR]

Hemolytic disease of the fetus and newborn (HDFN) results from the destruction of the newborn's red blood cells or the fetus by the mother's immune globulin G antibodies. Although HDFN is often caused by RhD and ABO incompatibility, it can also be seen due to minor blood groups such as Kell, Kidd, Duffy, P, MNS, or Rh subgroup (C, c, E, e) alloantibodies. Our study aims to share our experiences regarding a rare cause of HDFN. The files of patients who were followed up with the diagnosis of jaundice in a third-level Neonatology Unit of a university hospital between January 2014 and September 2023 were retrospectively examined. Eleven patients with Kell incompatibility were included in the study. There was no ABO/RhD incompatibility in any case. RhD subgroup incompatibility and Kell incompatibility were present in four cases. Phototherapy was applied to all patients. The patient, whose total bilirubin level was high despite phototherapy, was treated with an exchange transfusion. No complications were observed due to treatment or high total bilirubin. No significant difference was observed between the parameters evaluated according to the gender variable. It should be kept in mind that severe hemolysis and related deaths may occur due to Kell incompatibility. In order to reduce and prevent severe hemolysis due to Kell and other minor blood groups in newborns, transfusing blood products suitable for minor blood groups to women of childbearing age (especially pregnant women) may be a correct approach as a country policy. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine if treatment with IVIG of neonates with ABO incompatibility (without Rh incompatibility) results in decreased number of packed red blood cell (pRBC) transfusions and phototherapy use. Study Design An Institutional Review Board (IRB)-approved, single-institution retrospective study was conducted. Neonates ≥38 weeks' gestational age born between January 1, 2007, and December 31, 2016, with ABO incompatibility were included. The comparison among groups was performed using chi-square and Fisher's exact tests for categorical variables; continuous variables were assessed by Kruskal–Wallis test. Results Six hundred and sixty-eight neonates with ABO incompatibility met inclusion criteria, 579 were included in the analyses. From these, 431 (74%) neonates had positive Direct Antiglobulin Test (DAT); 98 (17%) received IVIG and 352 (61%) received phototherapy. Thirty-six (6%) neonates received pRBC and 6 (1%) required exchange transfusions. Only 3 (0.5%) infants received pRBC transfusions postdischarge, by 3 months of age. Neonates requiring IVIG had lower initial hemoglobin (13.6 vs. 16.0 g/dL, p ≤ 0.0001) and higher bilirubin at start of phototherapy (9.1 vs. 8.1 mg/dL, p = 0.0064). From the 42 (7%) neonates who received simple and exchange transfusions, IVIG use was not associated with decreased use or number of transfusions (p = 0.5148 and 0.3333, respectively). Newborns with A+ and B+ blood types had comparable initial hemoglobin, DAT positivity, APGAR, and bilirubin. However, infants with B+ blood group were more likely (than A +) to require phototherapy (p < 0.001), receive IVIG (p = 0.003), and need phototherapy for a longer duration (p = 0.001). Conclusion The results of this large retrospective study reveal that giving IVIG to neonates with ABO incompatibility was associated with increased simple or exchange transfusions. Newborns with B+ blood type required more phototherapy and IVIG. Further studies are needed to better stratify neonates who would benefit from IVIG use in order to optimize treatment strategies and avoid unnecessary risks and adverse events. Key Points IVIG use not associated with decreased use of pRBC or exchanges. Phototherapy duration associated with increased IVIG and pRBC use. Newborns with B+ blood type had worse hemolytic anemia. [ABSTRACT FROM AUTHOR]

In 2016, we initiated a quality improvement endeavor to increase pediatric heart offer acceptance. This study assessed the effect of these interventions at our center. We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance ("extended criteria"): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total cardiac volume (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2 infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes. During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (p = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (p < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (p = 0.04 and p < 0.001). There was no difference in post-HT intubation or intensive care unit days (p = 0.05-0.9), though post-transplant hospitalization duration (p < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (p = 0.3). We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival. [ABSTRACT FROM AUTHOR]

Low-titer O-positive whole blood was used extensively by the military during operations in Iraq and Afghanistan. Studies have consistently shown that this therapy is feasible, safe, and effective in the management of hemorrhagic shock in trauma patients, and it is now the standard of care across the US military Joint Trauma System. The military's success in using low-titer O-positive whole blood has renewed the practice in the civilian setting, with recent research confirming its safety and efficacy. In a few short years, use of this treatment for hemorrhagic shock has expanded to more than 80 US level I and level II trauma centers. However, its use is still relatively rare in the rural hospital setting. This article describes the benefits for patients, staff members, and the overall trauma system of using low-titer O-positive whole blood in rural hospitals. [ABSTRACT FROM AUTHOR]

Background: Acute rejection occurs at any time following renal transplantation. The study aims to find the incidence, risk factors, and outcome of acute rejection in kidney transplantation. Materials and Methods: Retrospective cohort study conducted from January 2015 to April 2023, included patients with biopsy-proven acute graft rejection. Data were collected from electronic medical records. Rejection and no rejection groups were compared for the variables. Results: Out of 371 patients, acute rejection occurred in 36 (9.7%) patients at 1 year of transplantation. Thirty (8%) were early acute rejections (EARs) and 22 (6%) were late acute rejections (LARs). Higher human leukocyte antigen (HLA) mismatches, historical positive crossmatch, and history of blood transfusions were risk factors for acute rejection (P < 0.05). Incidence of LAR beyond 1 year was 11/23 (48%) in those who had received induction therapy at transplantation versus 5/29 (17.2%) in those who did not (P = 0.045). One out of five patients (3.4%) who received antithymocyte globulin (ATG) experienced EAR, in contrast to 8/18 (5.2%) patients who received basiliximab (P = 0.037). A complete response to treatment was observed in 22/30 (73.3%) patients with EAR and 2/22 (9.09%) with LAR (P < 0.001). At 23.77 ± 24.6 months of follow-up, graft survival was 12/12 (100%) in those with early T-cell-mediated rejection (TCMR) compared to 5/9 (55.6%) with late acute TCMR (P = 0.01). Conclusion: The incidence of acute rejection was highest within the first posttransplant year. Higher HLA mismatches, historical positive crossmatch, and history of blood transfusion were risk factors for acute rejection. ATG was effective in preventing EAR. LAR occurring beyond the first posttransplant year was independent of induction therapy at time of transplantation. Treatment response was better with EAR compared to LAR. Graft survival was better with early acute TCMR compared to late acute TCMR. [ABSTRACT FROM AUTHOR]

The article discusses attitudes towards urgent RhD-positive transfusions in female patients and the risk of hemolytic disease of the fetus and newborn (HDFN). Surveys show a preference for issuing RhD-negative blood products to women and girls, but due to supply constraints, some centers use RhD-positive products in life-threatening situations. Studies indicate that the public values survival in trauma over the risk of future pregnancy complications, supporting the acceptance of RhD-positive transfusions if RhD-negative products are unavailable. Efforts should still be made to provide RhD-negative products to females of childbearing potential, but the surveys demonstrate a willingness to accept lifesaving interventions when necessary. [Extracted from the article]

We aimed to develop a novel method for measuring the complement-binding ability of anti-blood type antibodies (ab-Abs), the flow cytometry method for the complement C1q test (FCM-C1q) for detecting antibody-mediated rejection (AMR) caused by ab-Abs in ABO-incompatible kidney transplantation (ABOI-KTx). FCM-C1q distribution was surveyed in 44 healthy participants and 43 dialysis patients (Cohort A). The relationship between AMR and FCM-C1q levels was examined along with ab-Ab titers by the flow cytometry method for the IgG test (FCM-IgG) in 62 ABOI-KTx patients (Cohort B). FCM-IgG and C1q levels were significantly higher in type O participants than in A/B participants in Cohort A. There were minimal differences in the distribution of FCM-IgG and C1q between dialysis and healthy participants. Sixteen cases were suspected of acute rejections (ARs) in Cohort B, of whom nine had AR clinically. One patient with severe AMR was highly suspected of hyperacute rejection along with another patient with severe AMR. Their postoperative FCM-C1q and FCM-IgG levels were elevated. Another two patients showed high FCM-IgG and C1q levels before KTx, and these levels remained low after KTx with no or mild rejection. In conclusion, our results suggest that a high positivity rate for FCM-C1q may predict moderate to severe AMR caused by ab-Abs and poor prognosis in ABOI-KTx. [ABSTRACT FROM AUTHOR]

Objective: Neonatal jaundice is a common problem and is the most common cause of hospitalization. We aimed to determine the characteristics and etiological factors of late preterm and term newborns hospitalized due to indirect hyperbilirubinemia. Methods: Late preterm and term newborns hospitalized between January 1,2009 and December 31,2014 with a diagnosis of indirect hyperbilirubinemia were included. Demographic and clinical characteristics, duration, and patterns of treatment were obtained retrospectively. Etiological factors were determined. Result: Late preterm and term infants with indirect hyperbilirubinemia were included (n=412). 54.6% of the patients were male, 40.8 % were first babies, the mean gestational age was 38.3±1.1 weeks, and the mean birth weight was 3031±520 grams. 84.5 % were exclusively breastfed. The time of presentation was 4.6 ±2.6 days, and the serum total bilirubin level was 18.6 ±4.7 mg/dl. ABO incompatibility was found in 29 %, dehydration in 10.7 %, and Rh incompatibility in 7.1% of the patients. The mean duration of hospitalization was 3.1 ±2.2 days, and the mean duration of phototherapy was 44.8±22.8 hours. 16 patients received intravenous immunoglobulin. An exchange transfusion was performed in 14 patients. In the group with a serum total bilirubin level of ≥ 20 mg/dl, male gender and normal spontaneous vaginal delivery were statistically significantly higher than the group with a serum total bilirubin level below 20 mg/dl (p = 0.02 for both). Conclusion: Indirect hyperbilirubinaemia, which is common in the neonatal period, should be recognized early and is a treatable condition. We should promptly identify and treat the cause before complications arise. [ABSTRACT FROM AUTHOR]

In the 1990s, neonates born with severe congenital heart disease faced more than 50% mortality awaiting an ABO-compatible (ABOc) transplant donor. This desperate situation, together with knowledge of gaps in the adaptive immune system in early childhood, led to the clinical exploration of intentional ABO-incompatible (ABOi) heart transplantation. In 2001, West et al. reported the first series of 10 infants in Canada. Since then, consideration of ABOi heart donors has become the standard of care for children awaiting transplantation in the first few years of life, resulting in reduced wait times and better organ utilization with noninferior post-transplant outcomes compared to ABOc recipients. This state-of-the-art review discusses the clinical development and evolution, underlying and resulting immunological aspects, current challenges, and future directions of ABOi heart transplantation. [ABSTRACT FROM AUTHOR]

Background: Live donor kidney transplantation is considered the optimal choice for renal replacement therapy, providing established benefits, such as superior patient survival and improved quality of life. However, immunological challenges, including ABO blood group incompatibility and, particularly, donor‐specific HLA antibodies, may impact long‐term outcomes considerably or even prevent safe direct transplantation with the intended donor. Methods: In this review, the authors discuss kidney paired donation (KPD) as a viable strategy to overcome immunological barriers to living donation through organ exchanges. We thereby lay special focus on the Czech‐Austrian transnational KPD program. Results: While the benefits of KPD programs are well established for adult recipients, recent data suggest that this may hold true also for pediatric patients. Complex algorithms, considering factors like the intricate patterns of HLA sensitization, play a pivotal role in predicting suitable matches, but for pediatric patients also non‐immunological factors including age and weight match may play a role. As pool size proves crucial for program efficacy, several countries in Europe have now initiated transnational collaborations to maximize match rates. Among those, the Czech‐Austrian transnational joint program, established in 2015 and now expanded to a cooperation with the Israel transplant program to further increase transplant rates, represents a successful example. Conclusion: KPD programs, with their innovative approaches and international partnerships, hold promise for enhancing outcomes and addressing the increasing demand for kidney transplantation. [ABSTRACT FROM AUTHOR]

Patients with renal graft failure can develop human leukocyte antigen (HLA) sensitization when returning to dialysis. There is no consensus on which factors could be associated with an increased risk of this kind of sensitization after graft loss. To try to identify some of these factors, a retrospective observational study was performed in our center. Demographic and transplant-related data were collected: HLA mismatches, changes in calculated panel reactive antibody percentage over time, the immunosuppression withdrawal schedule during the first year on hemodialysis (HD), among others. Patients who developed anti-HLA antibodies after 1 year on HD had a greater number of total HLA mismatches (4.15 ± 1.3 vs 3.3 ± 1.1; P =.001), HLA-DR (1.35 ± 0.7 vs 0.7 ± 0.6; P =.001) and HLA-A mismatches (1.70 ± 0.5 vs 1.27 ± 0.7; P =.004) than patients who never developed anti-HLA antibodies. When we only analyzed patients who develop ≥98% calculated panel reactive antibody versus those who persist without anti-HLA antibodies, these differences were more evident (5.2 ± 1.1 MM vs 3.3 ± 1.1 MM; P <.001). The timing of discontinuation of immunosuppression did not influence sensitization. Thus, we have observed that HLA mismatches influence HLA sensitization after graft failure at least during the first year on HD. This study supports the importance of prioritizing HLA matching in patients who may require >1 graft over the years and being aware of the potential importance of HLA mismatches on sensitization on HD. [ABSTRACT FROM AUTHOR]

Biliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE). A 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe. Duct-to-duct biliary anastomosis was performed, and V5 and V8 of the graft were reconstructed using a vein graft. However, 5 months after surgery, magnetic resonance cholangiopancreatography revealed stricture of the bile duct anastomosis. Endoscopic stenting could not be attempted because of the sigmoidal bending of the bile duct. Instead, percutaneous transhepatic cholangiographic drainage (PTCD) of the anterior and posterior branches was performed. We attempted to remove the PTCD tube by an endofistulization technique. We performed the gun-sight technique, originally employed for transjugular intrahepatic portosystemic shunt procedures, to create a pathway for internal drainage of the posterior segment. The anterior lobe was abandoned by applying DHVE, resulting in no external drainage tubes. Application of the gun-sight technique with DHVE for sigmoidal refractory biliary stricture after LDLT appears to be a feasible treatment. [ABSTRACT FROM AUTHOR]

Objective: The presence of donor-specific antigens (human leukocyte antigen [HLA] incompatibility) leads to positive T-cell or B-cell crossmatch. Kidney transplant after desensitization protocols not only poses a financial burden on the patients but also there is an increased rate of infections and graft rejection. Paired kidney exchange (PKE) is cost-effective and offers better postoperative graft outcome. Methods: We included six pairs of kidney transplant donors and recipients for 6-way simultaneous PKE transplantation. These patients were ABO incompatible or HLA incompatible or both. Results: All patients underwent transplant in a single day without any perioperative surgical and anesthesia complications except for the need of mechanical ventilation in one patient in the postoperative care unit. The graft function was excellent in all recipients. Conclusion: This is the first 6-way simultaneous kidney exchange transplantation in the northwestern region of India. The inclusion of multiple donors and recipients for a paired exchange kidney transplant, although challenging, increases the donor pool and decreases the waiting time and financial constraints.

BACKGROUND: Due to platelet availability limitations, platelet units ABO mismatched to recipients are often transfused. However, since platelets express ABO antigens and are collected in plasma which may contain ABO isohemagglutinins, it remains controversial as to whether ABO non-identical platelet transfusions could potentially pose harm and/or have reduced efficacy. STUDY DESIGN AND METHODS: The large 4-year publicly available Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) database was used to investigate patient outcomes associated with ABO non-identical platelet transfusions. Outcomes included mortality, sepsis, and subsequent platelet transfusion requirements. RESULTS: Following adjustment for possible confounding factors, no statistically significant association between ABO non-identical platelet transfusion and increased risk of mortality was observed in the overall cohort of 21,176 recipients. However, when analyzed by diagnostic category and recipient ABO group, associations with increased mortality for major mismatched transfusions were noted in two of eight subpopulations. Hematology/Oncology blood group A and B recipients (but not group O) showed a Hazard Ratio (HR) of 1.29 (95%CI: 1.03-1.62) and intracerebral hemorrhage group O recipients (but not groups A and B) showed a HR of 1.75 (95%CI: 1.10-2.80). Major mismatched transfusions were associated with increased odds of receiving additional platelet transfusion each post-transfusion day (through day 5) regardless of the recipient blood group. DISCUSSION: We suggest that prospective studies are needed to determine if specific patient populations would benefit from receiving ABO identical platelet units. Our findings indicate that ABO-identical platelet products minimize patient exposure to additional platelet doses.

Isatuximab is an IgG1κ‐derived monoclonal antibody against CD38 approved for the treatment of adult patients with multiple myeloma. Here we describe the successful treatment of a therapy‐refractory pure red cell aplasia case following ABO‐mismatched allogeneic stem cell transplantation with isatuximab. Our patient was a 75‐year‐old female with acute myeloid leukemia who received an HLA‐B antigen mismatched, unrelated peripheral blood stem cell transplant with a major ABO incompatibility (blood group A+ in the donor and blood group O+ in the recipient). The patient developed persistent red cell aplasia and anti‐A antibodies for more than 500 days from transplant. She received therapy with rituximab, bortezomib, prednisone, and darbepoetin alfa with partial to no response. After repeated insurance denials for daratumumab, isatuximab was obtained from the manufacturer through their CareASSIST program. Following the completion of 2 cycles of isatuximab (8 doses), significant and sustained red cell recovery was observed. [ABSTRACT FROM AUTHOR]

Background: Although advancements in desensitization protocols have led to increased ABO-incompatible (ABOi) living-donor liver transplantation (LDLT), a higher biliary complication rate remains a problem. This study evaluated the effect of baseline anti-ABO antibody titers before desensitization on biliary complications after ABOi LDLT. Methods: The study cohort comprised 116 patients in the ABO-compatible group (ABOc), 29 in the ABOi with the low titer (<1:128) group (ABOi-L), and 14 in the high titer (≥1:128) group (ABOi-H). Results: Biliary complications occurred more frequently in the ABOi-H group than in the ABOi-L and ABOc groups (7 [50.0%] vs. 8 [27.6%] and 24 [20.7%], respectively, p = 0.041). Biliary complication-free survival was significantly worse in the ABOi-H group than in the other groups (p = 0.043). Diffuse intrahepatic biliary strictures occurred more frequently in the ABOi-H group than in the other groups (p = 0.005). Multivariable analysis revealed that the high anti-ABO antibody titer (≥1:128) is an independent risk factor for biliary complications (hazard ratio 3.943 [1.635–9.506]; p = 0.002). Conclusions: A high baseline anti-ABO antibody titer (≥1:128), female sex, and hepatic artery complications are significant risk factors for biliary complications. [ABSTRACT FROM AUTHOR]

Background and Objective: Early discharge following robot-assisted kidney transplantation (RAKT) is a cost-effective strategy for reducing healthcare expenses while maintaining favorable short- and long-term prognoses. This study aims to identify predictors of postoperative delayed discharge in RAKT patients and develop a predictive model to enhance clinical outcomes. Materials and Methods: This retrospective study included 146 patients aged 18 years and older who underwent RAKT at a single tertiary medical center from August 2020 to January 2024. Data were collected on demographics, comorbidities, social and medical histories, preoperative labs, surgical information, intraoperative data, and postoperative outcomes. The primary outcome was delayed postoperative discharge (length of hospital stay > 7 days). Risk factors for delayed discharge were identified through univariate and multivariate regression analyses, leading to the development of a risk scoring system, the effectiveness of which was evaluated through receiver operating characteristic curve analysis. Results: 110 patients (74.8%) were discharged within 7 days post-transplant, while 36 (24.7%) remained hospitalized for 8 days or longer. Univariate and multivariate logistic regression analyses identified ABO incompatibility, BUN levels, anesthesia time, and vasodilator use as risk factors for delayed discharge. The RAKT score, incorporating these factors, demonstrated a predictive performance with a C-statistic of 0.789. Conclusions: This study identified risk factors for delayed discharge after RAKT and developed a promising risk scoring system for real-world clinical application, potentially improving postoperative outcome stratification in RAKT recipients. [ABSTRACT FROM AUTHOR]

Background: Pure red cell aplasia (PRCA) is a possible complication after allogeneic hematopoietic stem cell transplantation (HSCT) with major ABO incompatibility. Patients experience delayed engraftment of the erythroid series, with prolonged transfusion-dependent anemia and iron overload. Methods: We performed a revision of the most recent literature about post-HSCT PRCA treatment procedures. Moreover, we conducted a retrospective study, over the last 13-years, which included all consecutive major ABO mismatched HSCT performed in our unit, with the aim to assess PRCA incidence, risk factors, and response to different treatments. Overall, 194 patients received a major ABO mismatched transplant from 2010 to 2022. For each patient, data about demographic and transplant characteristics, engraftment, blood transfusion, and possible treatment received were collected. Results: The literature review returned 23 eligible papers on PRCA treatment, with high success rate using plasma-exchange (PEX) and immunoadsorption procedures, daratumumab, and eltrombopag. Our study identified a total of 24 cases of PRCA. Among risk factors for PRCA development, we have found older recipient age (p=0.01), high pre-HSCT IgG and IgM IHA titer (p<0.0001), major rather than bidirectional ABO incompatibility (p=0.02), low T CD8 lymphocyte count in the graft (p=0.006), relative donor (p=0.02) and bone marrow as stem cell source (p=0.002). However, multivariate analysis confirmed only pre-HSCT IgG IHA titer as the unique risk factor for PRCA occurrence. The optimal cut-off value of pre-HSCT IgG IHA for PRCA development, resulted to be 1/64, with a 100% sensitivity and 68.8% specificity (p<0.0001). All patients with PRCA had received rhEPO and transfusion support and 20 patients received additional treatments like PEX, rituximab, and more recently daratumumab. Comprehensively, PEX and rituximab obtained a response in half of the cases, at a variable time, while the few cases of patients we treated with daratumumab suggest promising results. The overall response rate in our cohort was 75%, with significantly better survival (94.4% vs. 16.7%) and lower transplant-related mortality (6.3% vs. 80%) for PRCA responders. Conclusions: Standardized guidelines on when and how to treat PRCA are necessary because the current treatment is controversial among centers. [ABSTRACT FROM AUTHOR]

Background: Platelet inventory constraints necessitate ABO‐incompatible platelet transfusion. Many minimize the hemolytic impact by confirming low titre (LT) donor isohemagglutinins. This process is costly. Pathogen‐reduced platelets (PRP) in platelet additive solutions (PAS) will dilute plasma and decrease high‐titre isohemagglutinins (HT). We determined the proportion of HT platelets and incompatible transfusions for units suspended in plasma to reassess the need for titres following introduction of PRP/PAS. Study Design and Methods: Our titre method is manual tube (1:50) dilution of platelet supernatant from apheresis or whole blood derived buffy coat pools suspended in plasma, tested with A1/B red cells. Testing included 49,058 pooled and 11,738 apheresis platelets over 4 years. The HT proportion, rate of out‐of‐group transfusions, and hemolytic reactions were determined. The impact of PAS dilution was estimated. Results: Totally 60,796 platelet units were tested. Group O pooled and group B apheresis platelets had HT in 6.6% and 5.7%, respectively. Group A pooled and apheresis platelets included 2% with HT. Approximately 25% of platelets transfused were ABO‐incompatible and no hemolytic reactions were reported. Based on the proportions of PAS‐E and plasma for PRP platelets, plasma from each donor comprises 11 mL (6% of total volume) vs 20‐257 mL in untreated pools. PAS‐E will replace and dilute residual plasma by at least 50%. Discussion: Rare platelet pools may demonstrate HT. PRP platelets with PAS will reduce titres and may abrogate the need for titration. A strategy of group specific transfusion or transfusion of group A PRP platelet transfusions may be a safe alternative. [ABSTRACT FROM AUTHOR]

This study looked at a classical truth logic of multi-propositions that is new in some ways: [1] Alethic modalities were mixed with logical consistency and incompatibility in a single plate form, i.e., necessary consistency (NC), possible consistency (PC)/ possible incompatibility (PI) and impossible incompatibility (IPI); [2] multi-propositions were judged by individuals as either NC, PC/PI, or IPI; [3] Four quantifiers; All (∀), No (∼∀), Some (∃), and Some Not (∼∃) of four propositional modes and three shapes (, ▱ and) are used to evaluate predictions; and [4] it inspired by multi-propositional of dual-process theories (DPTs) of deduction and modal syllogistic of multi-propositions, from which logicians have derived general hypotheses. HP 1- Individuals will more likely to endorse inferences as PC/PI rather than NC. HP 2: It's easier to calculate that inference has PC/ PI if it has also NC. Generally, logicians predict more endorsing PC for NC than for PI proposition. HP 3: It's easier to calculate that inference is not NC if it is also not PC. Generally, logicians predict more PI than IPI proposition endorses as NC. A modal syllogistic as a classical truth logic is presented by multi-propositions (two premises and one inference), each one from four modes has quantifiers such as universal quantifiers and existential quantifier; ∀, ∼∀, ∃, and ∼ ∃. They were evaluated by a single-mental model (Experiment I) and a multi-mental model (Experiment II). Logicians applied the immediate inference task (IIT), evaluation task (ET), and production task (PT) to evaluate three experiments. The results of the experiments suggested that students mostly endorsed PC/PI inferences over NC inferences. Even when logicians divided PC/PI separately as PC and PI, individuals endorsed PC most likely as compared to NC, and PI than IPI. Logicians also highlighted fallacies that were continuously resisted and endorsed when students were asked to judge multi-propositions that had NC. The purpose of this experimental study is to present a glimpse of students' endorsement of multi-propositions and explain that each individual has a different working memory and intelligence. [ABSTRACT FROM AUTHOR]

BACKGROUND: High titers of anti-A and anti-B are considered to be one reason for hemolytic transfusion reactions and ABO hemolytic disease in fetus and neonates. There is no consensus for critical ABO antibody titers to guide transfusion or transplant decisions. Implementation of ABO titer measurement can favor reduction in transfusion reactions in nongroup "O" recipients. AIMS: This study aimed to understand the trend and quantification of anti-A and anti-B antibody titers in Group "O" donors in this geography. SUBJECTS AND METHODS: A prospective study was conducted in 218, Group "O" blood donors in the year 2021, during the COVID-19 pandemic. Immunoglobulin (Ig) M antibody titers were measured by hemagglutination and IgG titers by solid-phase red cell adherence. Antibody titers ≥128 for IgG and ≥64 for IgM were considered "high titers." Epi Info 7.1 software was used for statistical analysis, with P < 0.05 significant. RESULTS: About 96.75% of blood donors were male with a median age of 33.16 ± 8.8 years. ABO antibody titers ranged from 0 to 1024. The prevalence of titers of <128 for IgG anti-A and anti-B was 79.36% and 86.24%, respectively, and 88.53% for both anti-A and anti-B IgM (<64). High IgG anti-A antibody titers were exhibited in 20.64% and anti-B titers in 13.76% of donors. None of the recipients showed any hemolytic reactions. CONCLUSIONS: The donor population showed predominance of low isoagglutinin titers. Defining critical titers will help formulate institutional guidelines on ABO-incompatible platelet transfusions and transplants. The use of automation in ABO titer assays removes interobserver variations and offers precise, reproducible, and less labor-intensive assays in resource-constrained settings. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background and Objectives: Double-volume exchange transfusion (DVET) is a life-saving procedure that replaces a neonate's blood volume twice over with adult donor blood to treat neonatal hyperbilirubinemia and prevent kernicterus. This study assessed DVET's effectiveness in reducing total serum bilirubin (TSB) concentration in neonates at risk of kernicterus and examined the disease conditions that necessitate DVET. Methods: This observational study assessed the effectiveness of DVET in 104 neonates at risk of kernicterus. Neonates meeting the American Academy of Pediatrics guidelines were selected. Blood samples were collected before and 24 h after DVET for TSB estimation and complete blood count analysis. Blood components were selected based on ABO, Rh, and other minor blood group incompatibility. DVET was performed using the push–pull method. Results: This study of DVET in 104 neonates with hyperbilirubinemia found that DVET is an effective treatment, reducing TSB levels by 61.72% on average. The most common cause of hyperbilirubinemia was idiopathic (25.6%), followed by ABO incompatibility (22.12%) and anti-D alloimmunization (17.31%). In hypothyroid, preterm, and sepsis cases, hemoglobin levels decreased by an average of 17.7%, 12.9%, and 13.9%, respectively, after DVET. However, in cases of minor alloimmunization and anti-D alloimmunization, hemoglobin levels increased by an average of 29% and 40.5%, respectively, after DVET. The maximum decrease in TSB level was observed in cases of ABO incompatibility with sepsis (82%), while the minimum decrease was seen in neonates undergoing DVET due to sepsis (50%). The percentage reduction of TSB level after DVET was similar for different etiologies, ranging from 50.2% to 65.4%. Conclusion: DVET is a rarely used procedure in the age of phototherapy and intravenous immunoglobulin for neonatal hyperbilirubinemia. However, it is the only effective treatment for very high bilirubin levels to prevent kernicterus or bilirubin encephalopathy. [ABSTRACT FROM AUTHOR]

In lymphocyte crossmatch using flow cytometry (flow cytometric crossmatch, FCXM), the conventional tricolor FCXM protocol requires a mononuclear cell isolation step. To develop a new, more streamlined protocol, we introduced whole blood lysis (WBL) and CD45 fluorescence-triggered acquisition using 4-color flow cytometry. A total of 186 donor/recipient pairs for transplantation were classified into donor-specific human leukocyte antigen (HLA) alloantibody-positive (DSA+, n = 78) and DSA-negative (DSA−, n = 108) groups. The latter group was reclassified into blood group ABO-incompatible (ABOi, n = 56) and ABO-compatible (n = 52) subgroups. The WBL FCXM protocol with CD45 V500-C was optimized using a FACSLyric cytometer (BD Biosciences) with 3 lasers. Measurements for T cells or B cells were calculated as a mean fluorescence intensity (MFI) ratio (test divided by control). WBL FCXM was compared with conventional FCXM in each group. WBL FCXM showed no difference quantitatively compared with conventional FCXM, except for the B cell FCXM in the DSA− group (B cell MFI ratio: 1.06 ± 0.44 and 0.92 ± 0.41, respectively [ P =.0001]). There was no ABO antibody interference in the ABOi subgroup. Similar results were observed in the qualitative determinations of FCXM as follows: 1) In the DSA+ group, the sensitivity of B cell WBL FCXM (96.2%) showed no difference compared with that of conventional FCXM (91.0%, P =.2188) and 2) In the DSA− group, the specificity of T cell WBL FCXM (96.3%) showed no difference compared with that of conventional FCXM (98.1%, P =.6250). WBL FCXM reduced the turnaround time by 50 min compared with that by conventional FCXM. WBL FCXM demonstrated comparable assay performance to that of conventional FCXM. Because this new FCXM protocol is simple and does not compromise assay sensitivity, it has the potential to replace the conventional method in histocompatibility laboratory settings. [ABSTRACT FROM AUTHOR]

Neutralizing capacity measurement (NCM) of soluble ABH substances (SAS) in plasma was assessed to guide the selection of the appropriate ABO group of fresh-frozen plasma (FFP) for plasma exchange (PE) in blood group O recipients with ABO-incompatible transplantations. Neutralizing capacity was assessed by measuring anti-A and/or anti-B titers in samples comprising one unit of O FFP and 10 O EDTA plasma samples and subtracting the binary logarithm of the titer in each group with a saline dilution. Ten EDTA plasma samples with Lewis b (Leb) antigen positivity and 10 sets of pooled FFP from each blood group were used as diluents. In O FFP, the NCM values (mean±SD) were 3.4±0.52 (2.6±0.52) and 2.6±0.52 (1.5±0.3) in B and AB for IgM (total antibody) anti-B (both P <0.001), and in the 10 O EDTA plasma samples, they were 3.9±0.88 (3.1±0.88) and 3.2±0.79 (2.4±0.97) for IgM (P =0.0013) and total anti-B (P =0.025), respectively. In vitro analysis revealed that B FFP is more effective than AB FFP in reducing IgM and total anti-B antibody titers in O recipients, regardless of Leb antigen positivity. [ABSTRACT FROM AUTHOR]

Background: We report an obstetric case involving an RhD‐positive woman who had developed a red blood cell (RBC) antibody that was not detected until after delivery of a newborn, who presented with a positive direct antiglobulin test result. Immunohematology studies suggested that the maternal antibody was directed against a low‐prevalence antigen on the paternal and newborn RBCs. Results: Comprehensive blood group profiling by targeted exome sequencing revealed a novel nonsynonymous single nucleotide variant (SNV) RHCE c.486C>G (GenBank MZ326705) on the RHCE*Ce allele, for both the father and newborn. A subsequent genomic‐based study to profile blood groups in an Indigenous Australian population revealed the same SNV in 2 of 247 individuals. Serology testing showed that the maternal antibody reacted specifically with RBCs from these two individuals. Discussion: The maternal antibody was directed against a novel antigen in the Rh blood group system arising from an RHCE c.486C>G variant on the RHCE*Ce allele linked to RHD*01. The variant predicts a p.Asn162Lys change on the RhCE protein and has been registered as the 56th antigen in the Rh system, ISBT RH 004063. Conclusion: This antibody was of clinical significance, resulting in a mild to moderate hemolytic disease of the fetus and newborn (HDFN). In the past, the cause of such HDFN cases may have remained unresolved. Genomic sequencing combined with population studies now assists in resolving such cases. Further population studies have potential to inform the need to design population‐specific red cell antibody typing panels for antibody screening in the Australian population. [ABSTRACT FROM AUTHOR]