Saved in:
| Main Authors: | , |
|---|---|
| Format: | Artículo Open Access |
| Published: |
Wiley
2026
|
| Subjects: | |
| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70469 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Table of Contents:
- Effects of ABO‐Incompatible Blood Transfusion on Immune Response and Rejection After Organ Transplantation Peilu Hu Xiaohui Zhang Clinical Transplantation ABSTRACT Background Peri‐operative blood transfusion is common during solid‐organ transplantation, yet the impact of ABO‐incompatible (ABOi) blood exposure on post‐transplant immunity and acute rejection (AR) remains uncertain. Methods We assembled a multicenter cohort of 468 adult kidney, liver and heart recipients (2018–2024). Detailed, time‐stamped transfusion records were linked to serial immune‐phenotyping (30‐plex cytokines, flow‐cytometric cell subsets) collected from pre‐operative baseline to 12 months. The causal effect of ABOi transfusion on biopsy‐proven AR was estimated with marginal structural models that incorporated daily inverse‐probability‐of‐treatment weighting and Fine–Gray competing‐risk adjustment. We further developed static (XGBoost‐Cox) and dynamic attention‐LSTM models to predict 30‐, 90‐ and 365‐day AR; model interpretability employed SHAP values and integrated gradients. Results Fifty‐six recipients (12%) received ≥ 1 unit of ABOi blood. After adjustment for baseline characteristics, surgical bleeding, tacrolimus exposure and other time‐varying confounders, ABOi transfusion independently increased 1‐year AR risk (HR 1.65; 95% CI 1.12–2.44). A clear dose‐response was observed: transfusion of > 3 incompatible red‐cell units doubled AR incidence. ABOi exposure produced an early IL‐6 surge (80 pg mL − 1 vs 60 pg mL − 1 in controls, p < 0.001) and sustained elevation of CD8 + /Treg ratios. Unsupervised clustering of 10 immune markers identified a hyper‐inflammatory phenotype (Cluster A) with a two‐fold higher AR hazard, strongly correlated with ABOi load. The dynamic model achieved AUROCs of 0.83, 0.79 and 0.75 for 30‐, 90‐ and 365‐day prediction, respectively, and provided patient‐level risk passports 24 h before clinical rejection. Conclusions Peri‐operative ABOi transfusion is a modifiable, dose‐dependent driver of AR across solid‐organ transplants. Early IL‐6 release and cytotoxic T‐cell expansion constitute plausible biological mediators. Minimizing incompatible antigen load and leveraging dynamic risk analytics may improve graft surveillance and inform targeted immunomodulation. 10.1111/ctr.70469 http://onlinelibrary.wiley.com/termsAndConditions#vor