title: Impact of a transfusion-free program on non-Jehovah's Witness patients undergoing liver transplantation.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is associated with a large amount of blood loss. This article examines the impact of the initiation of a transfusion-free program in January 2000 for Jehovah's Witnesses (JWs) on the overall use of blood products in non-JW patients undergoing OLT.
  
  
  METHODS
  Retrospective review of OLT from January 1997 through December 2004.
  
  
  METHODS
  University of Southern California University Hospital.
  
  
  METHODS
  A total of 272 OLTs were performed on non-JW adults. This number includes 216 (79.4%) deceased donor and 56 (20.6%) living donor liver transplantations. Thirty-three OLTs were performed before January 2000 (ie, before the initiation of a transfusion-free program) (group 1), and 239 OLTs were performed after January 2000 (group 2). In group 2, all patients underwent OLT using cell-scavenging techniques and acute normovolemic hemodilution whenever feasible. Demographic, laboratory, and clinical data were collected and matched for severity of disease (model of end-stage liver disease [MELD] score). Transfusion records of packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP) were obtained from the University of Southern California blood bank.
  
  
  RESULTS
  In comparing group 2 with group 1, the mean MELD score was statistically significantly higher (P < .001), whereas the mean number of intraoperative PRBC and FFP transfusions was significantly lower (P = .03 and P = .004, respectively). The number of preoperative and postoperative PRBC, FFP, and platelet transfusions between the 2 groups was not statistically different.
  
  
  CONCLUSIONS
  The development of a transfusion-free surgical program for JW patients has had a positive impact on reducing the overall blood use in non-JW patients undergoing OLT, despite the increase in MELD score.
authors.affiliation: Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, Keck School of Medicine, and University Hospital, University of Southern California, Los Angeles, USA. nicolas.jabbour@integris-health.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jabbour
authors.forename: Singh
authors.initials: S
authors.lastname: Gagandeep
authors.forename: Haimesh
authors.initials: H
authors.lastname: Shah
authors.forename: Rod
authors.initials: R
authors.lastname: Mateo
authors.forename: Maria
authors.initials: M
authors.lastname: Stapfer
authors.forename: Yuri
authors.initials: Y
authors.lastname: Genyk
authors.forename: Linda
authors.initials: L
authors.lastname: Sher
authors.forename: Monika
authors.initials: M
authors.lastname: Zwierzchoniewska
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
authors.forename: Gary
authors.initials: G
authors.lastname: Zeger
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002102:Cadaver; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome