Despite the risks associated with transfusion, the medical community continues to view blood as a safe and abundant product.
Dr Jabbour and colleagues provide an effective strategy to accomplish orthotopic liver transplantation without transfusion.
The investigators performed 27 liver transplantations in Jehovah's Witness patients from 1999 to 2004.
The patients included 24 adults and 3 children from the University Hospital of Southern California.
The investigative team reported that 19 of the transplantations were living donor and eight were deceased donor liver.
Preoperative blood augmentation with erythropoietin and iron was achieved.
At induction, all liver donor's and 6 of 8 deceased donor liver recipients underwent acute normovolemic hemodilution.
|Graft and patient survival was100% with living donor vs 75% in the deceased donor recipients|
|Journal of the American College of Surgeons|
The team conducted the operation under conditions of moderate anemia and cell scavenging techniques were used.
Acute normovolemic hemodilution and salvaged blood were returned as needed during bleeding or on completion of transplantation.
The preoperative liver disease severity score was higher in the deceased donor group.
The investigators had 100% graft and patient survivals in the living donor group, and 75% in the deceased donor recipients.
The team noted that 2 deceased donor recipients died.
The investigators reported that the remaining patients are all alive and well, at a follow-up of 965 days with a living donor and 624 days with deceased donors.
Dr Jabbour's team concludes, “Preoperative blood augmentation and acute normovolemic hemodilution provide a safe cushion against operative blood loss.”
“Elective living donor liver transplantation allows full implementation of a transfusion-free strategy in the setting of early hepatic failure, portal hypertension, and anemia.”
“This feat is an important step toward global standardization of transfusion-free surgical practice and an important response to widespread blood shortages and transfusion risks.”