Liver transplantation in Jehovah's Witnesses: a case series

  • Fredy Ariza a. Service of Anesthesiology, Perioperative Medicine and Pain Clinic, Fundación Valle del Lili, Cali, Colombia. b. School of Health Sciences, Universidad ICESI, Cali, Colombia.
  • Daniel Arboleda-Palacios School of Health Sciences, Universidad ICESI, Cali, Colombia.
  • Sebastian Rosales Hooker-Herrera School of Health Sciences, Universidad ICESI, Cali, Colombia.
  • Eliana Manzi-Tarapués Center for Clinical Research, Fundación Valle del Lili, Cali, Colombia.
  • Luis Armando Caicedo-Rusca Transplant Unit, Fundación Valle del Lili, Cali, Colombia.
Keywords: Liver transplant, Jehovah's Witnesses, Blood transfusions, Viscoelastic tests, Case series

Abstract

Introduction:

Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products.

Objectives:

This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT.

Materials and methods:

A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days post-transplantation.

Results:

Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course.

Conclusion:

It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes.

References

1. Kasraian L, Nikeghbalian S, Karimi MH. Blood product transfusion in liver transplantation and its impact on short-term survival. Int J Organ Transplant Med 2018;9:105-111.

2. Lisman T, Porte RJ. Pathogenesis, prevention, and management of bleeding and thrombosis in patients with liver diseases. Res Pract Thromb Haemost 2017;1:150-161.

3. Chand NK, Subramanya HB, Rao GV. Management of patients who refuse blood transfusion. Indian J Anaesth 2014;58:658-664.

4. Massicotte L, Capitanio U, Beaulieu D, et al. Independent validation of a model predicting the need for packed red blood cell transfusion at liver transplantation. Transplantation 2009;88: 386-391.

5. Lekerika N, Gutiérrez Rico RM, Arco Vázquez J, et al. Predicting fluid responsiveness in patients undergoing orthotopic liver transplantation: effects on intraoperative blood transfusion and postoperative complications. Transplant Proc 2014;46:3087-3091.

6. Donohue CI, Mallett SV. Reducing transfusion requirements in liver transplantation. World J Transplant 2015;5:165-182.

7. Metcalf RA, Pagano MB, Hess JR, et al. A data-driven patient blood management strategy in liver transplantation. Vox Sang 2018;113:421-429.

8. Shander A, Javidroozi M, Perelman S, et al. From bloodless surgery to patient blood management. Mt Sinai J Med 2012;79:56-65.

9. Thompson MA, Redden DT, Glueckert L, et al. Risk factors associated with reoperation for bleeding following liver trans-plantation. HPB Surg 2014;2014:1-8.

10. Ramos HC, Todo S, Kang Y, et al. Liver transplantation without the use of blood products. Arch Surg 1994;129:528-532.

11. Detry O, Roover AD, Delwaide J, et al. Liver transplantation in Jehovah’s Witnesses. Transpl Int 2005;18:929-936.

12. Xia VW, Steadman RH. Antifibrinolytics in orthotopic liver transplantation: current status and controversies. Liver Transpl 2004;11:10-18.

13. Jeong JY, Jee HS, Koo BS, et al. Liver transplantation in Jehovah’s Witnesses: two cases report. Korean J Anesthesiol 2017;70:350-355.

14. Youssef LA, Spitalnik SL. Transfusion-related immunomodulation: a reappraisal. Curr Opin Hematol 2017;24:551-557.

15. Calabro S, Gallman A, Gowthaman U, et al. Bridging channel dendritic cells induce immunity to transfused red blood cells. J Exp Med 2016;213:887-896.

16. Gibb DR, Calabro S, Liu D, et al. The Nlrp3 inflammasome does not regulate alloimmunization to transfused red blood cells in mice. EBioMedicine 2016;9:77-86.

17. Jabbour N, Gagandeep S, Shah H, et al. Impact of a transfusion-free program on non-Jehovah’s Witness patients undergoing liver transplantation. Arch Surg 2006;141: 913-917.

18. Detry O, Deroover A, Delwaide J, et al. Avoiding blood products during liver transplantation. Transplant Proc 2005;37: 2869-2870.
How to Cite
1.
Ariza F, Arboleda-Palacios D, Rosales Hooker-Herrera S, Manzi-Tarapués E, Caicedo-Rusca LA. Liver transplantation in Jehovah’s Witnesses: a case series. Colomb. J. Anesthesiol. [Internet]. 2020 Apr. 1 [cited 2024 Mar. 29];48(2):85-90. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/137

Downloads

Download data is not yet available.
How to Cite
1.
Ariza F, Arboleda-Palacios D, Rosales Hooker-Herrera S, Manzi-Tarapués E, Caicedo-Rusca LA. Liver transplantation in Jehovah’s Witnesses: a case series. Colomb. J. Anesthesiol. [Internet]. 2020 Apr. 1 [cited 2024 Mar. 29];48(2):85-90. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/137
Section
Case Report / Case Series

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code