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Liver transplantation in a Jehovah's Witness with ankylosing spondylitis

C. Baldry, MDCM^*, S.B. Backman, MDCM PhD FRCPC^*, P. Metrakos, MDCM PhD FRCSC, J. Tchervenkov, MDCM FRCSC, J. Barkun, MDCM FRCSC and A. Moore, MD FRCPC^*

^* From the Departments of Anesthesia and
Surgery, Royal Victoria Hospital and McGill University, 687 Pine Ave. W., Montreal, QC, H3A 1A1 Canada.

Address correspondence to: Dr. S.B. Backman. Phone: 514-842-1231, local 4880; Fax: 514-843-1723; E-mail: mdba{at}musica.mcgill.ca

Purpose: Orthotopic liver transplantation is typically associated with large volume blood loss. Technological and pharmacological advances permit liver transplantation in patients who formerly were not candidates for this surgery because of strict limitations on blood product administration. We describe a liver transplant in a Jehovah's Witness with ankylosing spondylitis.

Clinical features: A 49-yr-old Jehovah's Witness with ankylosing spondylitis and end stage liver disease secondary to sclerosing cholangitis underwent orthotopic liver transplantation. Recombinant human erythropoietin (4,000 IU sc every two days for four weeks, then 4,000 IU sc every week) established a normal hemoglobin concentration preoperatively (>140 g•L^–1 compared with 120 g•L^–1 baseline). Intraoperatively, strategies for reducing risk of blood product transfusion included avoidance of hypothermia (T>35°C), minimal blood sampling (four 1 ml samples), normovolemic hemodilution (two units), administration of Aprotinin (2 million units bolus dose followed by infusion of 500,000 u•hr^–1), and return of blood (1,500 ml) scavenged from the operative field. Estimated blood loss was 2,200 ml. The preoperative and postoperative hemoglobin concentration was 147 g•L^–1 (hematocrit 0.45) and 123 g•L^–1 (hematocrit 0.37), respectively. No blood products were required and he was discharged three weeks postoperatively without complication.

Conclusion: Technological and pharmacological advances allow patients to undergo surgery traditionally associated with large volume blood loss with reduced risk of blood product administration.

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