scholarly journals Liver transplantation in Jehovah's Witnesses: a case series

1969 ◽  
Vol 48 (2) ◽  
pp. 85-90
Author(s):  
Fredy Ariza ◽  
Daniel Arboleda-Palacios ◽  
Sebastian Rosales Hooker-Herrera ◽  
Eliana Manzi-Tarapués ◽  
Luis Armando Caicedo-Rusca
Keyword(s):  
Liver Transplantation ◽  
Cell Mass ◽  
Case Series ◽  
Graft Dysfunction ◽  
Post Transplantation ◽  
Jehovah’S Witnesses ◽  
Intraoperative Bleeding ◽  
Jehovah's Witnesses ◽  
End Stage ◽  
To Receive

Introduction: Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products. Objectives: This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT. Materials and methods: A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days post-transplantation. Results: Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course. Conclusion: It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes.

scholarly journals Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

2019 ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Corradi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Venous Pressure ◽  
Cell Mass ◽  
Kidney Injury ◽  
Operative Management ◽  
Jehovah’S Witnesses ◽  
Septic Complications ◽  
Jehovah's Witnesses ◽  
Free Environment

Abstract Background. Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures. Methods. This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. Results In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

scholarly journals Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

2019 ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Corradi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Venous Pressure ◽  
Cell Mass ◽  
Kidney Injury ◽  
Operative Management ◽  
Jehovah’S Witnesses ◽  
Septic Complications ◽  
Jehovah's Witnesses ◽  
Free Environment

Abstract Background. Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures.Methods. This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. Results In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

scholarly journals Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

2019 ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Forfori ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Venous Pressure ◽  
Cell Mass ◽  
Kidney Injury ◽  
Operative Management ◽  
Jehovah’S Witnesses ◽  
Septic Complications ◽  
Jehovah's Witnesses ◽  
Replacement Treatment ◽  
Free Environment

Abstract Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We developed a peri-operative management pathway with strategies toward a transfusion-free environment in the respect of the patients’ religious beliefs. Briefly, our peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest LT program from deceased donors in JW patients that has been reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

scholarly journals Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

2020 ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Corradi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Venous Pressure ◽  
Cell Mass ◽  
Kidney Injury ◽  
Operative Management ◽  
Jehovah’S Witnesses ◽  
Septic Complications ◽  
Jehovah's Witnesses ◽  
Free Environment

Abstract Background . Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures. Methods . This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. Results In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions . Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

scholarly journals Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

2019 ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Corradi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Venous Pressure ◽  
Cell Mass ◽  
Kidney Injury ◽  
Operative Management ◽  
Jehovah’S Witnesses ◽  
Septic Complications ◽  
Jehovah's Witnesses ◽  
Replacement Treatment ◽  
Free Environment

Abstract Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We developed a peri-operative management pathway with strategies toward a transfusion-free environment in the respect of the patients’ religious beliefs. Briefly, our peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest LT program from deceased donors in JW patients that has been reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

Early Experiences With PEGylated Carboxyhemoglobin Bovine in Anemic Jehovah’s Witnesses: A Case Series and Review of the Literature

2018 ◽  
Vol 33 (3) ◽  
pp. 372-377 ◽  
Author(s):  
Sean McConachie ◽  
Krista Wahby ◽  
Zinah Almadrahi ◽  
Sheila Wilhelm
Keyword(s):  
Case Series ◽  
Stable Condition ◽  
Complex Nature ◽  
Blood Transfusions ◽  
Oxygen Carriers ◽  
Jehovah’S Witnesses ◽  
Clinical Safety ◽  
Jehovah's Witnesses ◽  
Pharmacologic Management ◽  
Oxygen Carrying Capacity

Jehovah’s Witnesses (JW) represent a complex patient population due to their refusal to accept blood transfusions on religious grounds. Pharmacologic management of anemic JW patients is limited to stimulation of hematopoiesis by iron and erythropoietin supplementation and reduction of blood loss by prothrombin complex concentrates (PCCs). Hemoglobin-based oxygen carriers (HBOCs) represent the only pharmacologic modality for JW patients capable of acutely increasing a patient’s oxygen carrying capacity in the setting of organ failure, yet clinical safety and efficacy data are lacking in this population. We report 3 cases in which the HBOC, PEGylated carboxyhemoglobin bovine (Sanguinate®), was requested under emergent circumstances for severely anemic (hemoglobin <5 g/dL) JW patients who refused blood transfusions. Two patients received PEGylated carboxyhemoglobin infusions for severe anemia, while the third patient died prior to receiving the medication. One patient who received Sanguinate died after 5 units of medication. The other patient’s hemoglobin recovered and she was discharged in stable condition. This series demonstrates the complex nature of the critically anemic JW population and highlights the clinical considerations of using HBOCs in clinical practice and the critical need for further research before they can be broadly recommended.

scholarly journals Imaging indications and findings in evaluation of lung transplant graft dysfunction and rejection

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Mnahi Bin Saeedan ◽  
Sanjay Mukhopadhyay ◽  
C. Randall Lane ◽  
Rahul D. Renapurkar
Keyword(s):  
Differential Diagnosis ◽  
Lung Transplant ◽  
Imaging Features ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Contrast Imaging ◽  
Post Transplantation ◽  
Post Transplant ◽  
End Stage

AbstractLung transplantation is a treatment option in end-stage lung disease. Complications can develop along a continuum in the immediate or longer post-transplant period, including surgical and technical complications, primary graft dysfunction, rejection, infections, post-transplant lymphoproliferative disorder, and recurrence of the primary disease. These complications have overlapping clinical and imaging features and often co-exist. Time of onset after transplant is helpful in narrowing the differential diagnosis. In the early post transplantation period, imaging findings are non-specific and need to be interpreted in the context of the clinical picture and other investigations. In contrast, imaging plays a key role in diagnosing and monitoring patients with chronic lung allograft dysfunction. The goal of this article is to review primary graft dysfunction, acute rejection, and chronic rejection with emphasis on the role of imaging, pathology findings, and differential diagnosis.

Pre-Liver Transplantation Evaluation and Listing

2019 ◽  
Vol 03 (04) ◽  
pp. 255-262
Author(s):  
Alexander Pan ◽  
Sean Koppe
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Comprehensive Evaluation ◽  
Organ Distribution ◽  
Post Transplantation ◽  
Term Survival ◽  
Transplant Candidates ◽  
Liver Transplant Waiting List ◽  
End Stage ◽  
Survival Risk

AbstractLiver transplantation provides a curative treatment option for patients with both acute and chronic liver disease, but the decision to list a patient for transplant should be an informed one to maximize post-transplantation benefit and survivability. Potential candidates meeting transplantation indications must undergo a comprehensive evaluation consisting of both physical, as well as psychiatric, assessment to be considered for transplantation. Once listed, a candidate's place on the liver transplant waiting list is determined predominantly by his or her Model for End-Stage Liver Disease (MELD)-Na score, which is a reliable tool to stratify short-term survival risk. The severity of certain conditions, however, is not accurately reflected by the MELD-Na score, and these particular diagnoses may be assigned MELD exception points. Herein, we discuss common indications for liver transplantation: the MELD system and its exceptions, the physical and psychosocial evaluation of potential transplant candidates, and some limitations of the current organ allocation system and efforts to reduce disparity in organ distribution.

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