Liver transplantation without the use of blood products

H. C. Ramos, S. Todo, Y. Kang, E. Felekouras, Howard Doyle, T. E. Starzl, I. Dawidson, M. Atik

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives: To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques. Design: Case series survey. Setting: Tertiary care, major university teaching hospital. Patients and Methods: Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding, and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up. Interventions: Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin. Main Outcome Measures: Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures. Results: All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Plateletpheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174 000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P<.05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327 000, 3.8% of which was related to transfusions. Conclusions: Orthotopic liver transplantation without the use of blood products is possible. Blood conservation techniques do not increase morbidity or mortality and can result in fewer transfusion-related, in-hospital charges.

Original languageEnglish (US)
Pages (from-to)528-533
Number of pages6
JournalArchives of Surgery
Volume129
Issue number5
StatePublished - 1994
Externally publishedYes

Fingerprint

Liver Transplantation
Plateletpheresis
Erythropoietin
Bloodless Medical and Surgical Procedures
Erythrocytes
Guidelines
Hemorrhage
Hospital Charges
Autologous Blood Transfusions
Postoperative Hemorrhage
Platelet-Rich Plasma
Viscera
Tertiary Healthcare
Hematocrit
Teaching Hospitals
Venous Thrombosis
Blood Transfusion
Reperfusion
Allografts
Albumins

ASJC Scopus subject areas

  • Surgery

Cite this

Ramos, H. C., Todo, S., Kang, Y., Felekouras, E., Doyle, H., Starzl, T. E., ... Atik, M. (1994). Liver transplantation without the use of blood products. Archives of Surgery, 129(5), 528-533.

Liver transplantation without the use of blood products. / Ramos, H. C.; Todo, S.; Kang, Y.; Felekouras, E.; Doyle, Howard; Starzl, T. E.; Dawidson, I.; Atik, M.

In: Archives of Surgery, Vol. 129, No. 5, 1994, p. 528-533.

Research output: Contribution to journalArticle

Ramos, HC, Todo, S, Kang, Y, Felekouras, E, Doyle, H, Starzl, TE, Dawidson, I & Atik, M 1994, 'Liver transplantation without the use of blood products', Archives of Surgery, vol. 129, no. 5, pp. 528-533.
Ramos HC, Todo S, Kang Y, Felekouras E, Doyle H, Starzl TE et al. Liver transplantation without the use of blood products. Archives of Surgery. 1994;129(5):528-533.
Ramos, H. C. ; Todo, S. ; Kang, Y. ; Felekouras, E. ; Doyle, Howard ; Starzl, T. E. ; Dawidson, I. ; Atik, M. / Liver transplantation without the use of blood products. In: Archives of Surgery. 1994 ; Vol. 129, No. 5. pp. 528-533.
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abstract = "Objectives: To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques. Design: Case series survey. Setting: Tertiary care, major university teaching hospital. Patients and Methods: Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding, and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up. Interventions: Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin. Main Outcome Measures: Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures. Results: All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Plateletpheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174 000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P<.05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327 000, 3.8{\%} of which was related to transfusions. Conclusions: Orthotopic liver transplantation without the use of blood products is possible. Blood conservation techniques do not increase morbidity or mortality and can result in fewer transfusion-related, in-hospital charges.",
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T1 - Liver transplantation without the use of blood products

AU - Ramos, H. C.

AU - Todo, S.

AU - Kang, Y.

AU - Felekouras, E.

AU - Doyle, Howard

AU - Starzl, T. E.

AU - Dawidson, I.

AU - Atik, M.

PY - 1994

Y1 - 1994

N2 - Objectives: To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques. Design: Case series survey. Setting: Tertiary care, major university teaching hospital. Patients and Methods: Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding, and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up. Interventions: Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin. Main Outcome Measures: Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures. Results: All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Plateletpheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174 000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P<.05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327 000, 3.8% of which was related to transfusions. Conclusions: Orthotopic liver transplantation without the use of blood products is possible. Blood conservation techniques do not increase morbidity or mortality and can result in fewer transfusion-related, in-hospital charges.

AB - Objectives: To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques. Design: Case series survey. Setting: Tertiary care, major university teaching hospital. Patients and Methods: Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding, and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up. Interventions: Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin. Main Outcome Measures: Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures. Results: All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Plateletpheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174 000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P<.05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327 000, 3.8% of which was related to transfusions. Conclusions: Orthotopic liver transplantation without the use of blood products is possible. Blood conservation techniques do not increase morbidity or mortality and can result in fewer transfusion-related, in-hospital charges.

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