A Prospective Study Investigating the Cost Effectiveness of Intraoperative Blood Salvage during Liver Transplantation

Phillips, Simon; Maguire, Donal; Deshpande, Rahul; Muiesan, Paolo; Bowles, Matthew; Rela, M.; Heaton, Nigel

doi:10.1097/01.tp.0000199318.17013.c5

Cited by 50 publications

(27 citation statements)

References 12 publications

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“…It has been reported that the levels of 2,3-DPG and ATP in recovered RBCs was higher than that in stored RBCs (22). In addition, it has been demonstrated that recovered blood cells exhibited an improved oxygen carrying capacity and stronger anti-infiltration capacity than stored blood cells, which reduce the incidence of metabolic acidosis and electrolyte imbalance caused by the infusion of a large number of stored blood cells (23). Other studies that compared intraoperative cell salvage with allogeneic blood transfusion have demonstrated an increased mean erythrocyte viability, increased 2,3-DPG (24,25) and increased ATP levels (26,27) in salvaged blood.…”

Section: Discussionmentioning

confidence: 96%

Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells

Liu

Fan

Lü

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to characterize the function and hemorheology of red blood cells (RBCs) recovered during liver transplantation surgery in patients with hepatitis B and decompensation. A total of 15 hepatitis B patients with decompensation who underwent liver transplantation surgery were included in the present study. Blood samples were recovered during the liver transplantation surgery using an Autologous Blood Recovery System. The morphology and structure of RBCs were characterized and compared between pre-operative and recovered blood samples. In addition, the physiological functions of RBCs were measured and compared between pre-operative and recovered blood samples. No significant differences in the morphological score, 2,3-diphosphoglycerate, Na + K + -ATPase, Ca 2+ -ATPase, Mg 2+ -ATPase, malondialdehyde and osmotic fragility were identified between RBCs in the pre-operative and recovered blood samples. The level of free hemoglobin in RBCs of the recovered blood samples was significantly higher than in the pre-operative blood samples (P<0.05). Mediumand high-shear blood viscosities in the recovered blood samples were significantly lower than those observed in the pre-operative blood samples (P<0.05). Casson viscosity in the recovered blood samples was significantly higher compared with the pre-operative blood samples. However, no significant differences (P>0.05) in the low-shear blood viscosity, plasma viscosity, relative blood viscosity, erythrocyte aggregation index or Casson yield stress were identified between recovered and pre-operative blood samples. These findings suggested that autologous blood transfusion in liver transplantation surgery in patients with hepatitis B and decompensation had no significant influence on the morphology, structure, function and hemorheology of RBCs.

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Section: Discussionmentioning

confidence: 96%

Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells

Liu

Fan

Lü

et al. 2017

Experimental and Therapeutic Medicine

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“…3,4 Liver transplant is associated with major use of allogeneic blood products, which places major demands on finite resources and increases recipient exposure to viral, bacterial, and protozoal diseases associated with transfusion-undesirable events in immunosuppressed patients. 1 During this procedure, abnormal bleeding typically occurs as a consequence of surgery, hemostatic dysfunction, and portal hypertension. The cause of abnormalities of hemostasis is multifactorial, including deficits in platelets and coagulation factors related to the existing liver disease and increased fibrinolysis.…”

Section: Introductionmentioning

confidence: 99%

“…Presently, 40% operations are performed without blood transfusion. 1,2 During liver transplant, there is a major amount of blood loss because of surgery and primary disease. By using a cell saver, the need for blood transfusion is markedly reduced.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Cell Saver Use in Living-Donor Liver Transplant

Kırnap

Tezcaner²,

Soy³

et al. 2015

Exp Clin Transplant

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Objectives: Liver transplant currently is the best treatment option for end-stage liver disease. During liver transplant, there is major blood loss due to surgery and primary disease. By using a cell saver, the need for blood transfusion is markedly reduced. In this study, we aimed to evaluate the efficacy of cell saver use on morbidity and mortality in livingdonor liver transplant. Materials and Methods:We retrospectively evaluated 178 living-donor liver transplants, performed from 2005 to 2013 in our center. ChildTurcotte-Pugh A patients, deceased-donor liver transplants, and liver transplants performed for fulminant hepatic failure were not included in this study. Intraoperative blood transfusion was done in all patients to keep hemoglobin level between 10 and 12 g/dL. Cell saver was used in all liver transplants except in patients with malignancy, hepatitis B, and hepatitis C. Results: We included 126 patients in the study. Cell saver was used in 84 liver transplants (66%). In 42 patients (34%), liver transplant was performed without a cell saver. In living-donor liver transplant with cell saver use, 10 mL/kg blood (range, 2-50 mL/kg blood) was transfused from the cell saver; in addition, 5 to 10 mL/kg allogeneic blood was transfused. In living-donor liver transplant without cell saver, 20 to 25 mL/kg allogeneic blood was transfused. Conclusions: During liver transplant, major blood transfusion is needed because of surgery and primary disease. Cell saver use markedly decreases the need for allogeneic blood transfusion and avoids adverse events of massive transfusion.

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“…Lack of t-PA clearance during the anhepatic phase allied to the burst release of t-PA associated with the reperfusion of the ischemic graft result in great amounts of circulating tissue-type plasminogen activator (t-PA), with the consequent pathological activation of the fibrinolytic system 3 . Intraoperative red blood cell salvage (IRCBS) and autologous transfusion is not routinely used as cost effectiveness is a major concern 1 . The aim of this study was to analyse the changes in the transfusion requirements with the routine use of intraoperative red blood cell salvage.…”

Section: Introductionmentioning

confidence: 99%

“…Liver transplantation is associated with significant use of allogenic blood products, which places considerable demands on finite resources and increases recipient exposure to viral, bacterial and protozoal diseases associated with transfusion, undesirable events in immunosuppressed patients 1 . Intraoperative bleeding and homologous transfusions, during liver transplantation, are associated with increased postoperative morbidity and mortality in the recepients 2 .…”

Section: Introductionmentioning

confidence: 99%

Impact of blood salvage during liver transplantation on reduction in transfusion requirements

Sankarankutty¹,

Teixeira²,

Souza³

et al. 2006

Acta Cir. Bras.

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Purpose:The aim of this study was to analyse the changes in transfusion requirements, in patients submitted to orthotopic liver transpantation from cadaveric donors, with the use of intraoperative red blood cell salvage (Cell Saver). Methods: Data from 41 transplants were analysed. Intraoperative blood loss was calculated from the cell salvage, suction and the swabs. The autologous and heterologous transfusions were recorded The red blood salvage was performed using the Cell Saver 5 System (Haemonetics).. For analysis the patients were divided in two groups: one that used the Cell Saver and another that didn´t. Results: The median age of the patients was 50 years and the main indication for liver transplantation was cirrhosis (35 cases -85.3%). The median blood loss was 8362 + 3994 ml (with the Cell Saver) and 10824 + 7002 ml (without the Cell Saver) and the median transfusion of heterologous packed red blood cells was 9,6 + 8 units (with the Cell Saver) compared to 22,3 + 21 units (without the Cell Saver). Conclusions: The Cells Saver has the potential to reduce the need for heterologous blood transfusion reducing the risks of transmissible diseases. Key words: Liver Transplantation. Cell Saver. Blood Transfusion. Liver Surgery. RESUMO Objetivo: O objetivo desse estudo foi analisar as mundanças na quantidade de transfusão necessária com uso doIntraoperative red blood cell salvage (Cell saver), em pacientes submetidos a transplante ortotópico de fígado, doador cadáver. Métodos: Foram avaliados dados de 41 pacientes submetidos a transplante de fígado. O sangramento foi calculado de acordo com débito do aspirador, compressas e captação do Cell saver. A reposição necessária foi avaliada de acordo com a quantidade de transfusão heteróloga e autóloga. Para análise dos dados os pacientes foram dividos em dois grupos: com e sem uso de Cell saver. Resultados: A mediana de idade foi 50 anos e principal indicação de transplante foi cirrose hepática com 35 casos (85,3%). A mediana de sangramento durante o procedimento cirúrgico 8362 + 3994 ml (com cell saver) e 10824 + 7002 ml (sem cell saver) e a mediana de transfusão de concentrado de hemácias heterólogo, durante o período de internação hospitalar 9,6 + 8 unidades (com cell saver) compar 22,3 + 21 unidades (sem cell saver). Conclusão: Uso de Cell Saver tem um potential para reduzir a quantidade de transfusão heteróloga, dimuindo o risco de transmissão de doenças.

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A Prospective Study Investigating the Cost Effectiveness of Intraoperative Blood Salvage during Liver Transplantation

Cited by 50 publications

References 12 publications

Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells

Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells

Efficacy of Cell Saver Use in Living-Donor Liver Transplant

Impact of blood salvage during liver transplantation on reduction in transfusion requirements

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