Liver transplantation in Jehovah's Witnesses: two cases report

Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 to 10.8 g/dl after 6 months of erythropoiesis-stimulation therapy. With the combination of acute normovolemic hemodilution, intraoperative cell salvage, and use of transfusion alternatives, liver transplantation was successfully performed without transfusion of blood products.

[1]  K. Torp,et al.  Intracardiac thrombosis during liver transplant: A 17‐year single‐institution study , 2015, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[2]  A. Roy,et al.  Classical Notions of Coagulation Revisited in Relation with Blood Losses, Transfusion Rate for 700 Consecutive Liver Transplantations , 2015, Seminars in Thrombosis & Hemostasis.

[3]  E. Thomson,et al.  Use of antifibrinolytics in liver transplantation. , 2014, British journal of anaesthesia.

[4]  Kenichi A. Tanaka,et al.  Fibrinogen and Hemostasis: A Primary Hemostatic Target for the Management of Acquired Bleeding , 2012, Anesthesia and analgesia.

[5]  Ahmed Darwish Liver transplant in Jehovah's Witnesses patients , 2011, Current opinion in organ transplantation.

[6]  R. Porte,et al.  Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences. , 2010, Blood.

[7]  B. Bein,et al.  Effects of Low Central Venous Pressure During Preanhepatic Phase on Blood Loss and Liver and Renal Function in Liver Transplantation , 2010, World Journal of Surgery.

[8]  S. Rangarajan,et al.  Fibrinogen concentrate for acquired hypofibrinogenaemic states , 2008, Transfusion medicine.

[9]  A. Roy,et al.  Evaluation of cell salvage autotransfusion utility during liver transplantation. , 2007, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[10]  Y. Genyk,et al.  Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah's Witnesses. , 2005, Journal of the American College of Surgeons.

[11]  M. Lamy,et al.  Liver transplantation in Jehovah's witnesses , 2005, Transplant international : official journal of the European Society for Organ Transplantation.

[12]  D. Spahn,et al.  Acute normovolemic hemodilution: physiology, limitations, and clinical use. , 2003, Journal of cardiothoracic and vascular anesthesia.

[13]  M. Bellamy,et al.  Use of recombinant human erythropoietin to facilitate liver transplantation in a Jehovah's Witness. , 1996, British journal of anaesthesia.

[14]  T. Starzl,et al.  Liver transplantation without the use of blood products. , 1994, Archives of surgery.

[15]  J. Apfelbaum Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. , 2015, Anesthesiology.