Clinical

Liver transplantation possible without blood transfusions

Last Updated: 2005-09-22 12:36:25 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Surgeons in California have succeeded in routinely transplanting livers without using blood transfusions in the recipients. "If we can do liver transplantation, which is one of the most difficult surgeries in the abdomen to do without blood transfusion, then we can pretty much do almost any surgery in the abdomen without blood transfusions," Dr. Singh Gagandeep told Reuters Health.

In the Journal of the American College of Surgeons for September 5, Dr. Gagandeep and his colleagues at the University of Southern California-University Hospital in Los Angeles report the strategies they used to treat 24 adult Jehovah's Witness patients, whose religion forbids the use of blood transfusions.

The 19 patients who received transplants from living donors were treated with erythropoietin, iron sulfate and folic acid to build up their hematocrit. A transjugular intrahepatic portal-systemic shunt was used in seven patients to treat upper gastrointestinal bleeding or to decrease portal pressure.

"Then when you take them to the operating room, meticulous surgical technique has to be there, but over and above that there are things you can do that can curtail blood loss," Dr. Gagandeep said.

One measure is to salvage blood lost during surgery and to re-infuse it. Another is to maintain acute normovolemic hemodilution, he explained, "reconstituting the intravascular component with fluids and collagen crystalloids, so the patient doesn't go into shock."

Other strategies included monitoring the intraoperative coagulation profile with a thromboelastogram, and treating patients with recombinant factor VIIa or Amicar as necessary for containing coagulopathy.

Finally, the surgeon noted, blood draws to monitor the patients' progress after surgery are used "judiciously."

All the patients survived except for two who had severe kidney dysfunction.

In addition to the liver transplant recipients, Dr. Gagandeep said, "We have performed 81 living donor liver hepatectomies in which we used only one unit of blood in one patient, so we have gotten it down to an art form."

"We should look at blood conservation not as an art but as a science," he added. "No matter how safe we make blood donation, there will always be the risk of disease transmission."

In 10 to 15 years from now, he predicted, "we hopefully will not have to use blood products at all, substituting synthetic products instead."

J Am Coll Surg 2005;201:412-417.