Development of a transfusion-free surgical program for Jehovah's
Witness patients undergoing liver transplantation also has helped
reduce the overall use of blood products for non-Jehovah's Witnesses
undergoing the procedure, according to a study in the September issue
of Archives of Surgery, one of the JAMA/Archives journals.

"Orthotopic liver transplantation [in which a patient's diseased liver
is removed and a donor liver transplanted into the same place] is
typically associated with a large volume of blood loss, resulting in
multiple transfusions and related complications," the authors describe
in background information in the article. "Transfusion-free surgery is
rapidly gaining much-needed attention primarily because of the concerns
surrounding transmission of diseases such as human immunodeficiency
virus, hepatitis C and other viral infections. Additionally, long-term
shortage of blood products and a paucity of alternatives put the system
under duress, resulting in cancellation or postponement of elective
cases."

Nicolas Jabbour, M.D., from the INTEGRIS Baptist Medical Center,
Oklahoma City, and colleagues analyzed the medical records of 365 adult
and pediatric orthotopic liver transplants performed from January 1997
through December 2004 at the University of Southern
California-University Hospital in Los Angeles. The investigators
evaluated the impact of the initiation of a transfusion-free program
for Jehovah's Witnesses undergoing liver transplantation on the overall
use of blood products in non-Jehovah's Witnesses undergoing the
procedure. The pediatric and Jehovah's Witness transplant recipients
were eliminated from the study, leaving only adult non-Jehovah's
Witness patients who either received a liver transplant from a deceased
donor or a living donor (n=272). These patients were categorized into
two groups based on the initiation of the Transfusion-Free Medicine and
Surgery Program at USC (for Jehovah's Witnesses) in January 2000. Group
1 consisted of recipients who received the liver transplant before
January 2000 and group 2 included all patients who underwent
transplantation after January 2000.

"Recipients in group 1 underwent orthotopic liver transplants without
intraoperative blood-saving or salvaging techniques, whereas all
transplant recipients in group 2 underwent intraoperative cell salvage
(ICS) and acute normovolemic hemodilution (ANH) whenever feasible," the
authors report. "ANH indicates a therapeutic initiative that involves
simultaneously removing the patient's blood and replacing it with
nonblood products..."

"In comparing group 2 with group 1, the mean (average) MELD [model of
end-stage liver disease] score was statistically significantly higher,
whereas the mean number of intraoperative PRBC (packed red blood cells)
and FFP (fresh frozen plasma) transfusions were significantly lower,"
the authors report. The MELD score describes the survival probability
of a patient with end-stage liver disease, with higher scores
indicating sicker patients. "The number of preoperative and
postoperative PRBC, FFP and platelet transfusions between the two
groups was not statistically different."

"The development of a transfusion-free surgical program for Jehovah's
Witness patients has had a positive impact on reducing the overall
blood use in non-Jehovah's Witness patients," the authors note.
According to the authors, autotransfusion decreases some of the
complications of transfusions, such as transmission of unknown
pathogens, and also helps to preserve blood bank resources, which
consequently reduces the overall procedure cost. "Surgeons are the
leading consumers of blood products, and it is important that we are
leaders in promoting transfusion-free techniques. In conclusion, we
propose that the recognized need to minimize the use of blood products
be elevated to the same level as antibiotic and deep venous thrombosis
prophylaxis (prevention)."