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Factors associated with immune hemolytic anemia after pediatric liver transplantation
Author(s) -
Rock Nathalie,
Ansari Marc,
Villard Jean,
FerrariLacraz Sylvie,
Waldvogel Sophie,
McLin Valérie Anne
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13230
Subject(s) - medicine , incidence (geometry) , liver transplantation , univariate analysis , anemia , hemolytic anemia , gastroenterology , pediatrics , transplantation , immunology , multivariate analysis , physics , optics
Immune‐mediated hemolytic anemia following SOT is a rare disorder, the risk factors for which are unknown. Our purpose was to analyze a seemingly increased incidence in our center with the aim to identify predisposing factors. This recipients single‐center retrospective study reviewed the medical records of 96 pediatric LT between 2000 and 2013. IHA was defined as acute anemia with a positive direct antiglobulin test. Seven cases of immune‐mediated hemolytic anemia were identified (incidence 8.5%). Three cases presented during the first 3 months following LT (early IHA ), and 4 presented later (late IHA ). All patients with late IHA required rituximab. Using univariate analysis, the following factors were associated with IHA onset: BA ( P = .04), younger age ( P = .04), and the use of IGL ‐1 preservation solution ( P = .05). Late IHA was associated with viral infections occurring beyond 3 months following LT , younger age, and BA ( P = .01). Overall, CMV infection was associated with the development of both early and late IHA : CMV ‐negative recipients who received an organ from a CMV ‐positive donor were more likely to develop IHA ( P = .035), and de novo CMV infection during the first year post‐ LT was associated with late IHA ( P = .03). IHA is a rare complication following pediatric LT , occurring more frequently in younger patients and patients with an initial diagnosis of BA . CMV ‐negative recipients and patients who experience a de novo CMV infection in the first year following LT seem particularly vulnerable. IGL ‐1 preservation solution may be associated with an increased likelihood of developing IHA , a novel finding which warrants further investigation.