coagulation; complication; haemorrhage; Jehovah; liver transplantation; living donor; surgery; transfusion
Résumé :
[en] For religious reasons, Jehovah's witnesses refuse transfusion of blood products (red cells, platelets, plasma), but may accept organ transplantation. The authors developed a multidisciplinary protocol for liver transplantation in Jehovah's witnesses. In a 6-year period, nine Jehovah's witness patients were listed for liver transplantation. They received preoperative erythropoietin therapy, with iron and folic acid that allowed significant haematocrit increase. Two patients underwent partial spleen embolization to increase platelet count. Seven patients underwent cadaveric whole liver transplantation, and two right lobe living-related liver transplantation, using continuous circuit cell saving system and high dose aprotinin. No patient received any blood product during the surgical procedure. One patient suffering from deep anaemia after living-related liver transplantation was transfused as required by his family, but died from aspergillus infection. One 6-year-old child was transfused against her parent's will. The authors demonstrated that it is possible to increase haematocrit and platelet levels in cirrhotic patients awaiting liver transplantation. They were able to reduce intraoperative need for blood products, allowing liver transplantation in prepared Jehovah's witness patients. This experience may be beneficial for non-Jehovah's witness liver transplant recipients.
Disciplines :
Chirurgie Gastroentérologie & hépatologie
Auteur, co-auteur :
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
De Roover, Arnaud ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Delwaide, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Gastro-Entérologie-Hépatologie
Kaba, Abdourahmane ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Joris, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Honore, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Meurisse, Michel ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgicale abdominale
Kaufman DB, Sutherland DE, Fryd DS, Ascher NL, Simmons RL, Najarian JS. A single-center experience of renal transplantation in thirteen Jehovah's Witnesses. Transplantation 1988; 45: 1045.
Figuero J, Vaidya A, Ciancio G, Olson L, Miller J, Burke GW. Simultaneous pancreas-kidney transplantation in Jehovah's Witness patients. Clin Transplant 2003; 17: 140.
Boggi U, Vistoli F, Del Chiaro M, et al. Kidney and pancreas transplants in Jehovah's witnesses: ethical and practical implications. Transplant Proc 2004; 36: 601.
Conte J, Orens J. Lung transplantation in a Jehovah's witness. J Heart Lung Transplant 1999; 18: 796.
Grande AM, Rinaldi M, D'Armini AM, Pellegrini C, Vigano M. Lung transplantation in a Jehovah's witness. Case report in a twinning procedure. J Cardiovasc Surg (Torino) 2003; 44: 131.
Ramos HC, Todo S, Kang Y, Felekouras E, Doyle HR, Starzl TE. Liver transplantation without the use of blood products. Arch Surg 1994; 129: 528.
Detry O, Honoré P, Delwaide J, Dondelinger RF, Meurisse M, Jacquet N. Liver transplantation in a Jehovah's witness. Lancet 1999; 356: 1680.
Seu P, Neelankanta G, Csete M, et al. Liver transplantation for fulminant hepatic failure in a Jehovah's witness. Clin Transplant 1996; 10: 404.
Snook NJ, O'Beirne HA, Enright S, Young Y, Bellamy MC. Use of recombinant human erythropoietin to facilitate liver transplantation in a Jehovah's witness. Br J Anaesth 1996; 76: 740.
Calne R. Art, Surgery and Transplantation. London: Williams and Wilkins, 1996.
Detry O, De Roover A, Kaba A, et al. Right lobe living-related liver transplantation in a Jehovah's witness. Transpl Int 2003; 16: 895.
Jabbour N, Genyk Y, Mateo R, et al. Live-donor liver transplantation: the USC experience. Acta Chir Belg 2001; 101: 220.
Jabbour N, Gagandeep S, Mateo R, et al. Live donor liver transplantation without blood products: strategies developed for Jehovah's Witnesses offer broad application. Ann Surg 2004; 240: 350.
Jabbour N, Gagandeep S, Bramstedt KA, et al. To do or not to do living donor hepatectomy in Jehovah's witnesses: single institution experience of the first 13 resections. Am J Transplant 2005; 5: 1141.
Porte RJ, Knot EA, Bontempo FA. Hemostasis in liver transplantation. Gastroenterobgy 1989; 97: 488.
Lamy M. Invited comments concerning the article entitled "A practical approach to ethical problems in surgical emergencies". Acta Chir Belg 2004; 104: 129.
Dondelinger RF, Kurdziel J. Embolization of the spleen. In: Dondelinger RF, Rossi P, Kurdziel J, Wallace S, eds. Interventional Radiology. New York: Thieme Medical Publishers, 1990: 505-512.
Belghiti J, Noun R, Sauvanet A. Temporary portocaval anastomosis with preservation of caval flow during orthotopic liver transplantation. Am J Surg 1995; 169: 277.
Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002; 346: 1074.
Williamson LM, Lowe S, Love EM, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. Br Med J 1999; 319: 16.
Barbara J, Flanagan P. Blood transfusion risk: protecting against the unknown. Br Med J 1998; 316: 717.
Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. First of two parts-blood transfusion. N Engl J Med 1999; 340: 438.
Chang H, Hall GA, Geerts WH, Greenwood C, McLeod RS, Sher GD. Allogeneic red blood cell transfusion is an independent risk factor for the development of postoperative bacterial infection. Vox Sang 2000; 78: 13.
Vamvakas EC. Transfusion-associated cancer recurrence and postoperative infection: meta-analysis of randomized, controlled clinical trials. Transfusion 1996; 36: 175.
Porte RJ, Molenaar I, Begliomini B, et al. Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind trial. Lancet 2000; 355: 1303.
Boylan JF, Klinck JR, Sandler AN, et al. Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation. Anesthesiology 1996; 85: 1043.
Dalmau A, Sabate A, Acosta F, et al. Tranexamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation. Anesth Analg 2000; 91: 29.
Hendriks H, Meijer K, De Wolf J, et al. Reduced transfusion requirements by recombinant factor VIIa in orthotopic liver transplantation. Transplantation 2001; 71: 402.
Cacciarelli T, Keefe E, Moore D, et al. Primary liver transplantation without transfusion of red blood cells. Surgery 1996; 120: 698.
Hendriks H, Van der Meer J, Klompmaker IJ, et al. Blood loss in orthotopic liver transplantation: a retrospective analysis of transfusion requirements and the effects of autotransfusion of cell saver blood in 164 consecutive patients. Blood Coagul Fibrinolysis 2000; 11(Suppl. 1): S87.
Williamson K, Taswell H, Rettke SR, Krom RA. Intraoperative autologous transfusion: its role in orthotopic liver transplantation. Mayo Clin Proc 1989; 64: 340.
Liu CL, Fan ST, Lo CM, et al. Living donor liver transplantation without the use of blood products. Hong Kong Med J 2002; 8: 192.
Detry O, De Roover A, Delwaide J, et al. Living related liver transplantation in adults: first year experience at the University of Liège. Acta Chir Belg 2004; 104: 166.
Goodnough LT, Monk TG, Andriole GL. Erythropoietin therapy. N Engl J Med 1997; 336: 933.
Corwin H, Gettinger A, Rodriguez R, et al. Efficacy of recombinant human erythropoietin in the critically ill patient: a randomized, double-blind, placebo-controlled trial. Crit Care Med 1999; 27: 2346.
Pivalizza EG, Tjia IM, Juneja HS, Cohen AM, Duke JH. Elective splenectomy in an anemic Jehovah's witness patient with cirrhosis. Anesth Analg 1998; 87: 529.
Troisi R, Colle I, Van Vlierberghe H, Hesse UJ, Cuomo O, de Hemptinne B. Splenectomy and liver transplantation. Transplant Proc 2001; 33: 1500.
Menegaux F, Baker E, Keefe E, Monge H, Esquivel C. Impact of transjugular intrahepatic portosystemic shunt on orthotopic liver transplantation. World J Surg 1994; 18: 866.
Millis J, Martin P, Gomes A, et al. Transjugular intrahepatic portosystemic shunts: impact on liver transplantation. Liver Transpl Surg 1995; 1: 229.
Lerut J, Laterre PF, Goffette P, et al. Transjugular intrahepatic portosystemic shunt and liver transplantation. Transpl Int 1996; 9: 370.
Jabbour N, Zajko A, Orons P, Irish W, Fung JJ, Selby RR. Does transjugular intrahepatic portosystemic shunt (TIPS) resolve thrombocytopenia associated with cirrhosis? Dig Dis Sci 1998; 43: 2459.
Bernstein D, Jeffers L, Erhardtsen E, et al. Recombinant Factor VIIa corrects prothrombin time in cirrhotic patients: a preliminary study. Gastroenterology 1997; 113: 1930.
Blumberg N, Heal JM. Transfusion and recipient immune function. Arch Pathol Lab Med 1989; 113: 246.
Triulzi DJ, Vanek K, Ryan DH, Blumberg N. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992; 32: 517.
Palomo Sanchez J, Jimenez C, Moreno Gonzalez E, et al. Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation. Hepatogastroenterology 1998; 1998: 1026.
Mor E, Jennings L, Gonwa TA, et al. The impact of operative bleeding on outcome in transplantation of the liver. Surg Gynecol Obstet 1993; 176: 219.
Tix AP, Frazier PA. The use of religious coping during stressful life events: main effects, moderation, and mediation. J Consult Clin Psychol 1998; 66: 411.
