Intraoperative blood salvage and leukocyte depletion during liver transplantation with bacterial contamination.
BACKGROUND
Bacterial contamination is considered to be a contraindication for intraoperative blood salvage (IBS) during OLT. The aims of this study were to evaluate the efficiency of the autotransfusion device with an additional leukocyte depletion filter (LDF) for eliminating bacterial contaminations, and its clinical outcomes in terms of post-operative infections during OLT.


METHODS
Forty-five patients with end-stage liver disease and cirrhotic ascites were enrolled in this study. The blood from the surgical field was collected and processed by an autotransfusion device (Cell Saver 5) and a LDF for bacteriological analysis. Among them, 12 patients with chronic severe hepatitis B received autologous transfusion for analysis of the effect on post-operative infections.


RESULTS
Spontaneous bacterial peritonitis (SBP) (p < 0.05, OR = 20.1) and a long duration of operation (p < 0.01, OR = 8.3) were found to be critical risk factors for contamination. Autotransfusion devices with an additional LDF significantly eliminated bacterial contaminants from shed blood (p < 0.05). About 33% (4/12) of the patients who received autologous transfusion with salvaged and filtered erythrocytes got post-operative bacterial infection.


CONCLUSIONS
Autotransfusion devices with an additional LDF could significantly eliminate bacterial contaminants of shed blood during OLT. The new mode of IBS might be a good option in reducing post-operative infections, and deserves a large-scale clinical trial.
Department of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Multi-organ Transplantation of Ministry of Public Health, Key Laboratory of Organ Transplantation of Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ting-Bo
TB
Liang
Jun-Jian
JJ
Li
Dong-Lin
DL
Li
Liang
L
Liang
Xue-Li
XL
Bai
Shu-Sen
SS
Zheng
D001804:Blood Transfusion, Autologous / Q000295:instrumentation* / Q000379:methods; D000075202:Contraindications; D016984:Enterococcus faecium / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D006509:Hepatitis B / Q000628:therapy; D006801:Humans; D007432:Intraoperative Period; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D047589:Leukocyte Reduction Procedures; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D010538:Peritonitis / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors