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The use of organ donor blood in liver transplantation
Gia Toan Tang1, Ruth Shaylor2, Victor Hui2
1Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia.
Insights
Donor-specific transfusion (DST) using blood from deceased organ donors is feasible and reduces bank red blood cell use in liver transplantation (LT). While graft survival was superior in the donor blood group, DST did not independently predict outcomes or affect rejection rates.
Area of Science:
- Transplantation immunology
- Hepatobiliary surgery
- Blood banking and transfusion medicine
Background:
- Discarded blood from deceased organ donors is a potential resource for donor-specific transfusion (DST) in liver transplantation (LT).
- Assessing the impact of DST on intraoperative blood product use, long-term graft and patient survival, and rejection frequency post-LT is crucial.
Purpose of the Study:
- To evaluate the feasibility and long-term outcomes of intraoperative donor-specific transfusion (DST) in liver transplantation (LT).
- To determine the effect of DST on intraoperative bank blood product usage, graft and patient survival, and rejection rates.
Main Methods:
- Retrospective analysis of 992 adult liver transplantations performed between 1993 and 2018.
- Comparison of outcomes between patients receiving donor blood (DB group, n=437) and those not receiving donor blood (NDB group, n=555).
- Assessment of intraoperative blood product usage, patient and graft survival, and acute/chronic rejection rates.
Main Results:
- Donor blood processing ensured safe levels of potassium, magnesium, and insulin.
- The donor blood group required fewer units of bank red blood cells (2 vs. 4 units, P=.01).
- Graft survival was significantly superior in the donor blood group (10-year survival 75% vs. 69%, P=.04), though DST was not an independent predictor. No significant differences in patient survival or rejection rates were observed.
Conclusions:
- This is the first large-cohort study demonstrating the feasibility of intraoperative DST in LT with appropriate safety checks.
- Donor-specific transfusion reduced the need for packed red blood cell transfusions.
- No differences in rejection rates or graft/patient survival were found between the groups.
Background:
Blood removed from organs during deceased donor organ procurement is routinely discarded but is a potential resource for donor-specific transfusion (DST) in subsequent liver transplantation (LT). This study retrospectively analyses the impact of DST on intraoperative bank blood product usage, long-term graft, and patient survival, as well as frequency of rejection post-LT.
Methods:
A total of 992 adult LT performed from 1993 to 2018 in a single quaternary center were included. Intraoperative blood product usage, patient, and graft survival, as well as acute and chronic rejection were assessed in patients who received blood retrieved from the organ donor, the "donor blood" (DB) group (n = 437) and patients who did not, the "no donor blood" (NDB) group (n = 555).
Results:
Processing of DB ensured safe levels of potassium, magnesium, and insulin. There were fewer units of bank red blood cells transfusion required in the DB group compared to NDB group (2 vs. 4 units, P = .01). Graft survival was significantly superior in the DB group (10-year survival 75% vs. 69%, respectively, P = .04) but DST was not an independent predictor of graft survival. There was no significant difference in patient survival or rejection between the groups. There was no difference in treated, biopsy-proven rejection between the two groups.
Conclusions:
This is the first large-cohort study assessing long-term outcomes of intraoperative DST in LT. The collection of organ donor blood and subsequent use in LT recipients appeared feasible with appropriate quality checks ensuring safety. DST resulted in a reduction in the use of packed red blood cells. There was no difference in the rate of rejection or graft or patient survival.
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