 |
|
Impact of a Transfusion-Free Program on Non–Jehovah's Witness Patients Undergoing Liver Transplantation
Nicolas Jabbour, MD;
Singh Gagandeep, MD;
Haimesh Shah, MD;
Rod Mateo, MD;
Maria Stapfer, MD;
Yuri Genyk, MD;
Linda Sher, MD;
Monika Zwierzchoniewska, MD;
Rick Selby, MD;
Gary Zeger, MD
Arch Surg. 2006;141:913-917.
Background Orthotopic liver transplantation (OLT) is associated with a large amount of blood loss. This article examines the impact of the initiation of a transfusion-free program in January 2000 for Jehovah's Witnesses (JWs) on the overall use of blood products in non-JW patients undergoing OLT.
Design Retrospective review of OLT from January 1997 through December 2004.
Setting University of Southern California University Hospital.
Patients A total of 272 OLTs were performed on non-JW adults. This number includes 216 (79.4%) deceased donor and 56 (20.6%) living donor liver transplantations. Thirty-three OLTs were performed before January 2000 (ie, before the initiation of a transfusion-free program) (group 1), and 239 OLTs were performed after January 2000 (group 2). In group 2, all patients underwent OLT using cell-scavenging techniques and acute normovolemic hemodilution whenever feasible. Demographic, laboratory, and clinical data were collected and matched for severity of disease (model of end-stage liver disease [MELD] score). Transfusion records of packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP) were obtained from the University of Southern California blood bank.
Results In comparing group 2 with group 1, the mean MELD score was statistically significantly higher (P<.001), whereas the mean number of intraoperative PRBC and FFP transfusions was significantly lower (P = .03 and P = .004, respectively). The number of preoperative and postoperative PRBC, FFP, and platelet transfusions between the 2 groups was not statistically different.
Conclusion The development of a transfusion-free surgical program for JW patients has had a positive impact on reducing the overall blood use in non-JW patients undergoing OLT, despite the increase in MELD score.
Author Affiliations: Divisions of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation (Drs Jabbour, Gagandeep, Shah, Mateo, Stapfer, Genyk, Sher, Zwierzchoniewska, and Selby) and Pathology (Dr Zeger), Keck School of Medicine, and University Hospital (Drs Jabbour, Gagandeep, Shah, Mateo, Stapfer, Genyk, Sher, Zwierzchoniewska, Selby, and Zeger), University of Southern California, Los Angeles. Dr Jabbour is currently at the Nazih Zuhdi Transplant Institute INTEGRIS Baptist Medical Center, Oklahoma City, Okla.
|
