From the Guidelines
In ABOI transplant, FFP given should belong to the recipient's blood group, not the donor's, to minimize the risk of transfusion reactions and ensure compatibility. This approach is crucial in reducing the recipient's antibodies against the donor organ and preventing the introduction of new antibodies that could target the transplanted organ or the recipient's own tissues. According to the guidelines outlined in the study 1, the blood group of the recipient should be compatible with that of the donor to avoid hyperacute rejection and graft failure.
- Key considerations in ABOI transplantation include:
- Avoiding the introduction of antibodies that could react against foreign antigens
- Reducing the recipient's antibodies against the donor organ through procedures like plasmapheresis and immunoadsorption
- Minimizing the risk of hemolytic reactions and other immunological complications during the perioperative period
- The use of recipient-matched FFP is supported by the recommendation that efforts to transplant kidneys from donors whose blood group is incompatible with the recipient should be considered experimental 1.
- By using FFP that matches the recipient's blood group, clinicians can ensure a safer and more compatible transfusion, which is essential for the success of the transplantation procedure.
From the Research
ABOI Transplant FFP
- In ABO-incompatible organ transplantation, the use of fresh-frozen plasma (FFP) as a replacement fluid is crucial in reducing ABO antibody levels in the recipients 2.
- The FFP used in this context can belong to either the donor or the recipient's blood group, but studies suggest that donor-type FFP is effective in preventing hemolytic reactions in major ABO-incompatible allogeneic stem cell transplants 3.
- The use of group AB FFP has been shown to be more effective in reducing ABO antibody levels than albumin, and it can be infused to group O recipients 2.
- Donor-type FFP has been used to reduce isohemagglutinin titers and prevent hemolysis in major ABO-mismatched hematopoietic stem cell transplants, with a threshold titer of 64 being identified as a potential cause of hemolysis 3.
Comparison of FFP and Albumin
- A study comparing the use of albumin and partial substitution with FFP in selective plasma exchange for ABO-incompatible kidney transplantation found that FFP was more effective in decreasing isoagglutinin titers, but had a higher incidence of side effects 4.
- Another study found that pre-transplant donor-type red cell transfusion was a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants 5.
Importance of ABO Compatibility
- ABO incompatibility can lead to hemolysis, particularly in the setting of red cell transfusion, and it is essential to prevent ABO incompatibility when possible and to anticipate complications when ABO incompatibility is unavoidable 6.
- The use of FFP and other strategies to reduce ABO antibody levels and prevent hemolytic reactions is critical in ensuring the success of ABO-incompatible transplants.