Liver transplant in Jehovah's Witnesses patients

Darwish, Ahmed

doi:10.1097/mot.0b013e328346dd36

Cited by 18 publications

(24 citation statements)

References 14 publications

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“…Uncontrolled bleeding leads to a combination of haemodilution, hypothermia, consumption of clotting factors, reduced oxygen delivery to tissues and resultant acidosis, which in turn exacerbates the clotting process further causing a vicious ‘bloody' circle. With advances in anaesthetic and surgical techniques, development of newer parenchymal transaction devices, vessel control instruments and haemostatic adjuncts, it should be possible to perform major liver resections and liver transplantation with minimal or no transfusion even in Jehovah's Witness patients [10,11,12]. With increasing safety, mortality rates as low as 1-2% in specialist centres have been reported [13].…”

Section: Introductionmentioning

confidence: 99%

Methods of Haemostasis During Liver Resection - A UK National Survey

et al. 2013

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Background: Although haemorrhage is a major cause of morbidity and mortality in liver surgery, there is very little available guidance on its management. Methods: The aim of this study was to identify current practice in the UK in this regard. An online survey was created and hepatobiliary (HPB) specialists who were members of a specialist society and others who were known practitioners were invited by e-mail to complete the survey anonymously. Results: Fifty-one percent responded (n = 36/70), and most of these respondents worked at large HPB centres (>100 liver resections/year; n = 24, 66%). Not all questionnaires were fully completed by the individual surgeons. Thirty-eight percent of the surgeons routinely used Pringle's manoeuvre. Most surgeons used ligation of the inflow vessels (n = 16, 44%) and stapled the outflow vessels (n = 15, 42%). The Cavitron ultrasonic surgical aspirator (CUSA; 54%, 13/24) was preferred for parenchymal transection. The majority routinely used haemostatic adjuncts (n = 22, 62%), whilst 33% (n = 12) used them occasionally. Twenty-three (64%) felt manufactured haemostatic adjuncts played a major role in maintaining haemostasis and 19 preferred fibrin-based products. Conclusion: The Pringle manoeuvre is a popular technique amongst specialist UK liver surgeons and the CUSA is used by nearly half of the surgeons. Despite the absence of definitive evidence for their benefit, manufactured haemostatic adjuncts are still widely used, especially the fibrin-based adjuncts.

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Section: Introductionmentioning

confidence: 99%

Methods of Haemostasis During Liver Resection - A UK National Survey

et al. 2013

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“…Few case reports and case series have suggested that the use of CS might increase the risk of acute respiratory distress syndrome, acute renal failure or disseminated intravascular coagulopathy due to debris released from salvaged erythrocytes [8]. This has not been confirmed in a subsequent study [44]. Another potential risk associated with CS is the bacterial contamination of blood suctioned from the surgical field.…”

Section: Non-pharmacological Interventionsmentioning

confidence: 64%

“…Another potential risk associated with CS is the bacterial contamination of blood suctioned from the surgical field. The above-mentioned study showed that despite the fact that blood washing was not able to eliminate all bacterial contamination, autotransfusion of salvaged blood, was not associated with an increased rate of positive blood cultures and risk of postoperative infections [44]. To minimize the risk of bacterial contamination it is recommended to start collecting blood after the removal of ascitic fluid and cease it once biliary anastomosis begins [34].…”

Section: Non-pharmacological Interventionsmentioning

confidence: 99%

Perioperative bleeding in patients undergoing liver transplantation

Starczewska

Giercuszkiewicz²,

Niewiński³

et al. 2016

Anaesthesiol Intensive Ther

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Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years, significant progress in surgical technique and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipients outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during recipients have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.Key words: liver transplantation, perioperative management, haemostasis, bleeding Anaesthesiology Intensive Therapy 2016, vol. 48, no 1, 34-40 Liver transplantation (LT) remains one of the most challenging surgical technique. For many years, uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During more than the fifty years of experience gained since the first LT was performed by Thomas Starzl in 1963, an improvement in surgical techniques and anaesthetic management has led to a marked change in transfusion practices over time. A recently published retrospective analysis of data from the Mayo Clinic in Rochester has shown that over the last two decades there has been a significant decrease in the amount of perioperatively transfused red blood cells (RBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate and intraoperative autotransfusions [1]. Interestingly, this was noted despite the fact that transfusion triggers remained the same over time [1]. Massicotte et al. [2] reported that currently up to 79.6% of LTs are performed without any blood product transfusion. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in management of haemostasis in LT recipients. HAEMOSTATIC ALTERATIONS IN LIVER TRANSPLANT RECIPIENTSThe change in transfusion practices was possible due to a better understanding of alterations in the haemostatic system in LT recipients. The l...

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“…With the improvement of surgical techniques and anesthesia practices, the amount of blood transfused has been dramatically reduced [1][2][3]. Some centers achieved avoidance of RBC transfusion in up to 40% of liver recipients [4][5][6][7], and bloodless OLT has been reported in single cases and case series [8][9][10][11][12][13][14][15][16]. Also contributing to this trend is the increasing awareness of the hazards associated with blood transfusion in OLT [4,17,18], which have been observed in patients receiving red blood cells, platelets and plasma products [17,19,20].…”

Section: Introductionmentioning

confidence: 97%

“…The former presents a unique ethical dilemma in Jehovah's Witnesses patients, who on the basis of religious beliefs refuse transfusion of blood products [8][9][10][11][12][13][14][15][16]21]. The reliance on blood transfusion may also delay OLT in patients with numerous red blood cell alloantibodies or with deficiencies in IgA or haptoglobin [22,23].…”

Section: Introductionmentioning

confidence: 99%