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Transfusion-free program has positive impact in liver transplants

The transfusion-free surgical program for Jehovah Witness patients reduces the overall blood use in non-Jehovah Witness patients undergoing orthotopic liver transplant, finds this month's Archives of Surgery.

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Orthotopic liver transplantation is associated with a large amount of blood loss.

Dr Nicolas Jabbour and colleagues from California examined the impact of the initiation of a transfusion-free program for Jehovah's Witnesses in 2000.

The research team assessed the impact of this program on the overall use of blood products in non-Jehovah Witness patients undergoing orthotopic liver transplantation.

The researchers conducted a retrospective review of orthotopic liver transplantation from 1997 through 2004.

A total of 272 orthotopic liver transplantation were performed on non-Jehovah's Witness adults.

This number includes 216 deceased donor and 56 living donor liver transplantations.

Fresh frozen plasma transfusions were significantly lower in Group 2
Archives of Surgery

The team included the 33 orthotopic liver transplantation performed before the initiation of a transfusion-free program in Group 1.

The 239 orthotopic liver transplantation performed after 2000 were allocated to Group 2.

In Group 2, all patients underwent orthotopic liver transplantation using cell-scavenging techniques and acute normovolemic hemodilution whenever feasible.

The team collected demographic, laboratory, and clinical data, and matched these for severity of disease using the model of end-stage liver disease score (MELD).

Transfusion records of packed red blood cells, platelets, and fresh frozen plasma were obtained from the University of Southern California blood bank.

The researchers found that the mean MELD score was statistically significantly higher in Group 2 vs Group 1

However, the mean number of intraoperative packed red blood cells and fresh frozen plasma transfusions was significantly lower in Group 2.

The team observed that the number of preoperative and postoperative packed red blood cells, fresh frozen plasma, and platelet transfusions between the 2 groups was not statistically different.

Dr Jabbour's team concludes, “The development of a transfusion-free surgical program for Jehovah Witness patients has had a positive impact on reducing the overall blood use in non-Jehovah Witness patients undergoing orthotopic liver transplantation, despite the increase in MELD score.”

Arch Surg 2006: 141(9): 913-917
25 September 2006

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