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JEHOVAH’S WITNESS: CAN LIVER TRANSPLANTATION BE SAFELY PERFORMED?
F Aba-Alkhail, P Marotta
Liver Transplant Unit, London Health Sciences Center, University of Western Ontario, London, Ontario
BACKGROUND: orthotropic liver transplantation (OLT) is usually associated with significant blood loss and frequently requires the usage of blood products. Jehovah’s witnesses (JW) are usually excluded from liver transplant consideration, due to their refusal to accept blood products for religious reasons. This peculiar situation renders them very difficult candidates for such procedure. Several innovations had made surgery safer in these patients and they are, the pre-operative use of erythropoietin to increase red cell mass, the use of intraoperative cell salvage and acute normovoloemic hemodilution and judicious postoperative blood testing. Thoughtful preoperative decision making and careful surgical techniques remain the cornerstone to a successful outcome.
We report our experience in six JW’s that had OLT in our institution without blood transfusion. There were four adults and two children who had the successful procedure. All the indications for the OLT were heterogonous in nature and different post-operative course. Three of those patients had cirrhosis secondary to viral hepatitis, were 2 of them had HCV (with Child-Pugh class = C, and = B respectively) and one had HBV (who had Child-Pugh class= C). While the last adult patient had primary biliary cirrhosis (with Child-Pugh class= C). On the other hand the other 2 children got the transplant done were one of them had biliary Artesia and the other child had Alagille’s syndrome. In the post-operative period, none of the patients developed any complications, except one the patients who required a longer stay in the intensive care unit for hemodynamic instability and low hemoglobin post-operatively which he recovered from after being treated with erythropoietin and IV iron therapy. Most of the patients received an average of 750 ml of their own blood intraoprativly. All the patients were discharged in good health with no acute or chronic transplant complications with a mean follow up of 4 year.
CONCLUSION: multidisciplinary preparation and meticulous surgical technique and continuous cell saver may allow successful liver transplantation in JW’s who shouldn’t necessary be excluded from this life saving procedure.