A colleague in the Pacific Northwest is attempting to standardize the ordering of blood components for solid organ transplant candidates and recipients and would like to know if any transfusion medicine experts do not recommend the use of leukocyte-reduced components for liver transplant candidates/recipients considering the conflicting data regarding 1 year graft survival in two studies: Takaya S, et al. The adverse impact of liver transplantation of using positive cytotoxic crossmatch donors. Transplantation 1992, 53:400-406 and Lobo PI, et al. The lack of long term detrimental effects on liver allografts caused by donor-specific anti-HLA antibodies. Transplantation 1993, 55:1063 - 1066.

In addition, the Pacific Northwest colleague would like to know if medical centers consider leukocyte-reduced components equivalent to CMV antibody negative donor products ("CMV-safe") for solid organ transplant recipients (see prior discussion "How prevalent is leukocyte reduction by filtration as a method of providing 'CMV-safe' blood components?") in light of W. Garrett Nichols' published manuscript (Blood; 15 May 2003; Vol 101; N 10; p. 4195-4200) which provides data on the risks of CMV infection in stem cell transplant patients.

The following response has been received.

ADDENDA May 11, 2004

1. A colleague in Rochester, New York reports that at his hospital, they use leukoreduced blood for all their patient transfusion, but his opinion with regards to the specific setting mentioned is as follows:

• "For most solid organ transplants, alloimmunization to HLA antigens is considered a poor prognostic sign for organ rejection and clinical outcomes. The preponderant data for liver may not be that clear, but it's quite clear for kidney and heart. So leukoreduction makes sense to prevent allosensitization in patients awaiting allografts."
• "Leukoreduction may reduce morbidity and mortality in operative setting transfusions, but data in the organ transplant setting is certainly not definitive. But there's little reason to think the beneficial effects of leukoreduction in some cohorts of GI or cardiac surgery patients would not also be seen in other surgical settings." In his opinion, the weight of evidence from both randomized trials and observational studies support using leukoreduced transfusions for all surgical patients.
• At his hospital, they use leukoreduction as equivalent to CMV serotesting for all recipients. The randomized trials and observational data are heavily on the side of their equivalence, in his opinion, despite one observational study that questions this approach. He reports that their experience appears to support their use of leukocyte-reduced blood products in that de novo CMV disease in previously seronegative recipients of seronegative allografts has not occurred in his institution after 'thousands of transplants of various sorts'. He would channel savings through avoiding the expense of CMV serotesting to extending the use of leukoreduced transfusions to more patients if that were possible.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator