title: Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah's Witnesses.
abstract: BACKGROUND
  Despite the risks associated with transfusion, the medical community continues to view blood as a safe and abundant product. In this article, we provide an effective strategy to accomplish orthotopic liver transplantation without transfusion.
  
  
  METHODS
  From June 1999 through July 2004, 27 liver transplantations were performed in Jehovah's Witness patients at the USC-University Hospital (24 adults, 3 children). Nineteen of these were living donor (LD) and eight were deceased donor (DD) liver transplants. Preoperative blood augmentation with erythropoietin and iron was achieved. At induction, all LD and six of eight DD recipients underwent acute normovolemic hemodilution (ANH), and the operation was conducted under conditions of moderate anemia. Cell scavenging techniques were used. Acute normovolemic hemodilution and salvaged blood were returned as needed during bleeding or on completion of transplantation.
  
  
  RESULTS
  The preoperative liver disease severity score was higher in the deceased donor group. We had 100% graft and patient survivals in the LD group, and 75% in the DD recipients. Two DD recipients died. The remaining are all alive and well, with a mean followup of 965 days (range 266 to 1,979 days) in the LD group and 624 days (range 119 to 1,132 days) in the DD group.
  
  
  CONCLUSIONS
  Preoperative blood augmentation and acute normovolemic hemodilution provide a safe cushion against operative blood loss. Elective living donor liver transplantation allows full implementation of a transfusion-free strategy in the setting of early hepatic failure, portal hypertension, and anemia. This feat is an important step toward global standardization of transfusion-free surgical practice and an important response to widespread blood shortages and transfusion risks.
authors.affiliation: The Division of Hepatobiliary/Pancreatic Surgery and Transplantation Surgery, University of Southern California-University Hospital and Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jabbour
authors.forename: Singh
authors.initials: S
authors.lastname: Gagandeep
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mateo
authors.forename: Linda
authors.initials: L
authors.lastname: Sher
authors.forename: Yuri
authors.initials: Y
authors.lastname: Genyk
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000379:methods / Q000706:statistics & numerical data; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D006438:Hemodilution; D006801:Humans; D033221:Jehovah's Witnesses; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013997:Time Factors