Leukocyte reduction during orthotopic liver transplantation and postoperative outcome: a pilot study.
OBJECTIVE
To investigate the effect of intraoperative leukocyte reduction of administered blood products on the incidence of acute cellular rejection and postoperative patient outcome.


METHODS
Prospective, nonrandomized, historical control study.


METHODS
Academic tertiary medical center.


METHODS
The study group (Group 1) consisted of 30 consecutive adult patients with end-stage liver disease scheduled to undergo orthotopic liver transplantation (OLT) between 1998 and 2000. The historical control group (Group 2) consisted of 30 adult patients with end-stage liver disease matched to study group patients as closely as possible for age, gender, and etiology of liver disease who underwent OLT between 1995 and 1999.


METHODS
Group 1 patients had all intraoperative allogeneic and cell salvaged blood products leukocyte reduced before administration. Group 2 patients underwent OLT without leukocyte filtration of any administered blood products.


METHODS
Demographic data were collected for both patient groups and included age, gender, etiology of liver disease, and both intraoperative and postoperative immunosuppression. Demographic allograft donor data for both patient groups were collected and included age, gender, use of vasopressors during procurement, and cold and warm donor organ ischemic times. Outcome variables measured included incidence of acute cellular rejection, length of intensive care unit (ICU) and length of hospital stay, incidence of both graft loss and retransplantation, and mortality.


RESULTS
The incidence of acute cellular rejection was 40% in Group 1 and 66.7% in Group 2 (p = 0.037). Length of ICU stay was 3.0 (2.0, 5.0) days in Group 1 and 4.0 (3.0, 6.0) days in Group 2 (p = 0.16). Length of hospital stay was 14.0 (11.0, 18.0) days in Group 1 and 18.0 (14.0, 27.0) days in Group 2 (p = 0.035). One allograft was lost in Group 2 because of primary nonfunction requiring retransplantation (p = 0.31), and three postoperative deaths occurred in Group 1 as a result of multisystem organ failure (p = 0.08).


CONCLUSIONS
Coincident with leukocyte reduction of all administered blood products during OLT, an improved outcome was observed in Group 1 patients as demonstrated by both a decreased incidence of acute cellular rejection and length of hospital stay.
Parker
Brian M
BM
Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. parkerb1@ccf.org
Irefin
Samuel A
SA
Sabharwal
Vivek
V
Tetzlaff
John E
JE
Beven
Carrie
C
Younossi
Zobair
Z
Karafa
Matthew T
MT
Vogt
David P
DP
Henderson
J Michael
JM
D000208:Acute Disease; D000328:Adult; D001803:Blood Transfusion; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay; D007937:Leukapheresis; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
D007166:Immunosuppressive Agents