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

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

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

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: 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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Diego Costanzo ◽  
Maria Bindi ◽  
Davide Ghinolfi ◽  
Massimo Esposito ◽  
Francesco Corradi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Single Institution ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses

scholarly journals Liver transplantation in Jehovah's Witnesses: two cases report

2017 ◽  
Vol 70 (3) ◽  
pp. 350 ◽  
Author(s):  
Ju-Young Jeong ◽  
Hyeon Sook Jee ◽  
Bon-Sung Koo ◽  
Sung-Hwan Cho ◽  
Sang-Hyun Kim ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses

scholarly journals Liver transplantation in Jehovah's witnesses

2005 ◽  
Vol 18 (8) ◽  
pp. 929-936 ◽  
Author(s):  
Olivier Detry ◽  
Arnaud De Roover ◽  
Jean Delwaide ◽  
Abdour Kaba ◽  
Jean Joris ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses

scholarly journals LIVER TRANSPLANTATION IN JEHOVAH'S WITNESSES PATIENTS IN A CENTER OF NORTHEASTERN BRAZIL

2013 ◽  
Vol 50 (2) ◽  
pp. 138-140 ◽  
Author(s):  
José Huygens Parente GARCIA ◽  
Gustavo Rego COELHO ◽  
Bartolomeu Alves FEITOSA NETO ◽  
Emmanuel Almeida NOGUEIRA ◽  
Cayo César Góis TEIXEIRA ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Therapeutic Option ◽  
Organ Transplant ◽  
Fresh Frozen Plasma ◽  
University Hospital ◽  
Northeastern Brazil ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Coagulation Parameters ◽  
Transfusion Requirements

Context 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. Method 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 mm 3 ± 148000, 128,000 mm 3 ± 34836, 65,000 mm 3 ± 33496, 234,250 mm 3 ± 287003 and INR, 143 ± 0.10, 2.4 ± 0.34, 1.24 ± 0.10, 1.14 ± 0.09. Conclusion 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.

Sign in / Sign up

Export Citation Format

Share Document