A data‐driven patient blood management strategy in liver transplantation

Metcalf, Ryan A.; Pagano, Monica B.; Hess, John R.; Reyes, Jorgé; Perkins, James D.; Montenovo, Martin I.

doi:10.1111/vox.12650

Cited by 13 publications

(11 citation statements)

References 33 publications

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“…Age at the time of LT was 51 [44.5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease [7], was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5%) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4%), primary biliary cirrhosis (n = 1, 7.7%), alpha-1 antitrypsin deficiency (n = 1, 7.7%) and hemochromatosis (n = 1, 7.7%), (…”

Section: Resultsmentioning

confidence: 99%

“…Predicting cases requiring peri-operative transfusions is very desirable, particularly in JW patients, but it remains a very difficult task in LT [8,11,12]. In fact, despite several investigations have attempted to identify preoperative predictors of blood transfusion, their value remain inconsistent and weak [2,[8][9][10][11][12][13][14]. In recent years, models to predict blood utilization with preoperative variables have been proposed [11,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, despite several investigations have attempted to identify preoperative predictors of blood transfusion, their value remain inconsistent and weak [2,[8][9][10][11][12][13][14]. In recent years, models to predict blood utilization with preoperative variables have been proposed [11,14,15]. However, their limitations and differences in the results highlight significant concerns about their generalizability and recognize that it may be very difficult to develop a single, reliable, and universally applicable model to predict transfusion requirements for patients undergoing LT.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

et al. 2020

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Background: Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures. Methods: This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, venovenous bypass and low central venous pressure. Results: In a 9-year period, 13 Jehovah's Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyperfibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions: Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

et al. 2020

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“…5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease 8 , was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5 %) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4 %), primary biliary cirrhosis (n = 1, 7.7 %), alpha-1 antitrypsin deficiency (n = 1, 7.7 %) and hemochromatosis (n = 1, 7.7 %), ( Table 2 whereas Table 3 Finally, of the 13 JW recipients, 12 (92.3 %) were alive at the 1 year follow-up interview: 1 patient died 11 months from LT due to ischemic-type biliary lesions (ITBL)-related septic complications.…”

Section: Resultsmentioning

confidence: 99%

“…Predicting cases requiring peri-operative transfusions is very desirable, particularly in JW patients, but it remains a very difficult task in LT 9,[12][13] . In fact, despite several investigations have attempted to identify preoperative predictors of blood transfusion, their value remain inconsistent and weak 3,[9][10][11][12][13][14][15] . In recent years, models to predict blood utilization with preoperative variables have been proposed 12,[15][16] .…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

Costanzo

Bindi

Ghinolfi

et al. 2019

Preprint

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Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We developed a peri-operative management pathway with strategies toward a transfusion-free environment in the respect of the patients’ religious beliefs. Briefly, our peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest LT program from deceased donors in JW patients that has been reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

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Recipient Selection in DCD Liver Transplantation

Bohórquez

Cohen

Loss

2020

Donation After Circulatory Death (DCD) Liver Transplantation

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A data‐driven patient blood management strategy in liver transplantation

Abstract: Patients likely to require low or high pRBC transfusion volumes were identified with excellent accuracy using this predictive model at our institution. This model may help predict bleeding risk for each patient and facilitate optimized blood ordering.

Cited by 13 publications

References 33 publications

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

Recipient Selection in DCD Liver Transplantation

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