September 22, 2005

Liver transplant possible without transfusion

By Karla Gale

NEW YORK (Reuters Health) - Surgeons in California have
succeeded in routinely transplanting livers without using blood
transfusions in the recipients. "If we can do liver
transplantation, which is one of the most difficult surgeries
in the abdomen to do without blood transfusion, then we can
pretty much do almost any surgery in the abdomen without blood
transfusions," Dr. Singh Gagandeep told Reuters Health.

In the Journal of the American College of Surgeons,
Gagandeep and his colleagues at the University of Southern
California-University Hospital in Los Angeles describe the
strategies they used to treat 24 adult Jehovah's Witness
patients, whose religion forbids the use of blood transfusions.

The 19 patients who received transplants from living donors
were treated with drugs and supplements to build up their red
blood cells. A shut was used in seven patients to check upper
gastrointestinal bleeding or to decrease pressure.

"Then when you take them to the operating room, meticulous
surgical technique has to be there, but over and above that
there are things you can do that can curtail blood loss,"
Gagandeep said.

One measure is to salvage blood lost during surgery and to
re-infuse it. Another is to maintain normal fluid levels in the
circulation, he explained, "so the patient doesn't go into

Other strategies include monitoring coagulation components
in the blood and treating patients with drugs as needed.
Finally, the surgeon noted, blood monitoring to assess the
patients' progress after surgery should be used "judiciously."

All the patients survived except for two who had severe
kidney dysfunction.

In addition to the liver transplant recipients, Gagandeep
said, they have conducted 81 procedures to remove a portion of
the liver from donors "in which we used only one unit of blood
in one patient, so we have gotten it down to an art form."

"We should look at blood conservation not as an art but as
a science," he added. "No matter how safe we make blood
donation, there will always be the risk of disease

In 10 to 15 years from now, he predicted, "we hopefully
will not have to use blood products at all, substituting
synthetic products instead."

SOURCE: Journal of the American College of Surgeons,
September 5, 2005.