title: Liver transplantation in Jehovah's Witnesses patients in a center of northeastern Brazil.
abstract: BACKGROUND
  Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease and acute liver failure. Currently, Brazil has a well-established public organ transplant program, performing 7,425 solid organs transplants in 2012 alone, among which 1,595 were liver transplants. Jehovah's Witnesses report 7,6 million members worldwide. For religious reasons they refuse transfusion of whole blood or its primary components (red cells, fresh frozen plasma, platelets).
  
  
  OBJECTIVE
  This study aims to present the results obtained with Jehovah's Witnesses patients by a liver transplantation service.
  
  
  METHODS
  We conducted a retrospective review of medical records from Jehovah's Witnesses patients (n=4) who underwent orthotopic liver transplantation from September 2009 to September 2011 at the Walter Cantídio University Hospital of the Federal University of Ceará, Fortaleza, CE, Brazil. Coagulation parameters such as Hemoglobin, Hematocrit, Platelets, INR were evaluated during the preoperative, immediate postoperative, postoperative day (POD) 7 and POD 30.
  
  
  RESULTS
  Coagulation parameters were expressed as means: hematocrit, 35.07%±6.65%, 24.6%±4.74%, 19.85%±2.10%, 31.85%±5.99%; hemoglobin, 12.57 g/dL±2.22, 8.92 g/dL±1.75, 6.92 g/dL±0.58, 11.17 g/dL±0.9; platelets, 160,975 mm3±148000, 128,000 mm3±34836, 65,000 mm3±33496, 234,250 mm3±287003 and INR, 143±0.10, 2.4±0.34, 1.24±0.10, 1.14±0.09.
  
  
  CONCLUSIONS
  Liver transplantation can successfully be performed in Jehovah's Witnesses patient population provided that: 1) the medical team has extensive expertise in that field, 2) the patient has an adequate level of hematologic factors preoperatively, and 3) there is availability of specialized equipment such as cell saver to minimize blood loss and thus avoid transfusion requirements.
authors.affiliation: Centro de Transplante de Fígado do Ceará, Department of Surgery and Liver Transplantation, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: José Huygens Parente
authors.initials: JH
authors.lastname: Garcia
authors.forename: Gustavo Rego
authors.initials: GR
authors.lastname: Coelho
authors.forename: Bartolomeu Alves
authors.initials: BA
authors.lastname: Feitosa Neto
authors.forename: Emmanuel Almeida
authors.initials: EA
authors.lastname: Nogueira
authors.forename: Cayo César Góis
authors.initials: CC
authors.lastname: Teixeira
authors.forename: Denissa Ferreira Gomes
authors.initials: DF
authors.lastname: Mesquita
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult