Complex liver resection for a large intrahepatic cholangiocarcinoma in a Jehovah's witness: A strategy to avoid transfusion

Abstract

Although morbidity and mortality after liver resection have improved over the last two decades, complex liver resections still require perioperative blood transfusions. In this report, we describe the use of a combined left trisegmentectomy and caudate lobectomy, along with resection of the inferior vena cava, to treat a large intrahepatic cholangiocarcinoma in a Jehovah's Witness. To our knowledge, this is the first report of major liver resection for a large malignant tumor in this patient population. We also discuss the perioperative strategy and surgical technique we used to minimize blood loss and avoid transfusion. This approach could be a safe alternative for use in all patients with complex liver tumor, regardless of their religious beliefs, to reduce the risks and cost associated with blood transfusion.

Safety and feasibility of elective liver resection in adult Jehovah's Witnesses: the Henri Mondor Hospital experience

“…In contrast with other studies, the current series did not use either acute normovolemic hemodilution or acute hypervolemic hemodilution. 2,3,8 A cell saver and attending personnel were available in the operating room in all patients as a safety net in the event of significant hemorrhage and were actually installed in one fifth of all patients; however, no patients received returned blood due to insufficient yield. In the systematic review, the cell saver was installed in 94% of patients, and blood was returned in 30% of them.…”

“…Despite tremendous progress in the perioperative management of liver resection, reports of this procedure in JW patients remain scarce; all the existing studies are case reports and small case series. [1][2][3][4][5][6][7][8][9] Yet, blood transfusion rate remains far from zero, even in the most recent period (3.7% and 7.6% for minor and major resections respectively. 10 The aim of the present study was to report the Henri Mondor experience with liver resection in JWs and analyze it in terms of optimal management, feasibility and safety in light of current knowledge obtained through a systematic review of published studies.…”

Preoperative left hepatic lobe devascularisation to minimize perioperative bleeding in a Jehovah’s Witness undergoing left hepatectomy

“…Whilst use of total vascular isolation and controlled hypoperfusion in liver resection for an intrahepatic cholangiocarcinoma has been reported [4], we report a case of preoperative total left hepatic lobe devascularisation to minimize perioperative bleeding in a Jehovah’s Witness. For Jehovah’s Witness patients, blood transfusion is not a therapeutic option.…”