Jehovah's Witnesses refuse blood transfusions but accept solid organ transplants. Six Jehovah's Witnesses received a kidney and/or a pancreas transplant in our center. After a mean follow-up of 31.4 months (range: 18 to 39) all the recipients are alive and well with functioning grafts. However, 1 month after grafting, one recipient required blood transfusions. Hemorrhage was ruled out and the anemia was attributed to drug-related toxicity. Thus, Jehovah's Witnesses can receive a kidney and/or a pancreas transplant without blood transfusions at the time of surgery. However, lifesaving transfusions may be needed later on, which raises additional and unique medical and ethical issues.

Kidney and pancreas transplants in jehovah’s witnesses

Transfusion challenges in hematology oncology and hematopoietic stem cell transplant - Literature review and local experience.

Background Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and methods From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were 11.6 ± 1.8 g/dL and 11.7 ± 1.7 g/dL, respectively; and the nadir Hb level post operation and the final Hb level before discharge were 8.3 ± 1.6 g/dL and 10.2 ± 1.6 g/dL, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience.

Introducción: El trasplante renal es la mejor terapia para la mayoría de los pacientes con insuficiencia renal crónica terminal. Nuestro programa inició el 21 de septiembre del 2006. Objetivo: Describir la experiencia del programa de trasplante renal de nuestro hospital, enfatizando en la tasa de supervivencia injerto/paciente y los factores que influyen en la misma. Material y métodos: Estudio retrospectivo de trasplantes renales realizados en nuestro hospital del 21 de septiembre del 2006 al presente. Se registraron variables sociodemográficas, relacionadas con el trasplante, estatus serológico de citomegalovirus, complicaciones, inducción, inmunosupresión inicial y actual. Se evaluó tasa de rechazo agudo, función renal, número y tipo de infecciones, causas de muerte y pérdida del injerto. La supervivencia del paciente y del injerto no censurada a los años uno, tres y cinco postrasplante fue calculada mediante Kaplan-Meier (log-rango). Resultados: Se realizaron 95 trasplantes, 43 de donante vivo y 52 de fallecido. La supervivencia global del paciente fue de 94.7, 85.2 y 77.9% a uno, cinco y 10 años respectivamente. La supervivencia global del injerto fue de 87.2, 59.7 y 43.8% a uno, cinco y 10 años respectivamente. La inmunosupresión inicial, el retraso en la función del injerto y las infecciones disminuyeron la supervivencia global significativamente. A su vez, la hospitalización postrasplante influyó de manera substancial en la supervivencia del injerto de donante fallecido. Conclusión: Se debe enfatizar en la profilaxis anti-infecciosa y en el régimen de inmunosupresión para mejorar la supervivencia del injerto en nuestro programa.

/pdf/analisis-de-la-supervivencia-a-10-anos-de-trasplante-renal-51b08fg47p.pdf

Análisis de la supervivencia a 10 años de trasplante renal en el Hospital de Alta Especialidad de Veracruz

In Latin America, few reports are available about the clinical outcomes of living donor kidney transplants (LDKT). We aim to evaluate the main clinical outcomes for LDKT patients in a single center's experience. We retrospectively evaluated 530 LDKT patients who underwent transplantation from August 2008 to December 2020 at Colombiana de Trasplantes. Graft survival censored for death and patient survival were determined up to 5 years post-transplantation by the Kaplan-Meier method. Vascular and urinary complications, readmission, and reintervention rates were documented. A total of 530 LDKT patients were analyzed. Most of the recipients were men (56%). There were 123 patients (23.2%) with a preemptive transplant. Panel reactive antibody type I and II had higher immunologic risk (>20%) in 15.9% of the patients. The donor mean age was 37.8 ± 11.5 years. Most of the donors were women (52.6%) and related to the recipient (69.1%). Multivariate analysis identified panel reactive antibody type II (P = 0.003), female donor (P = 0.001), surgical reintervention at 30 days post-transplantation (P < .01), and delayed graft function (P < .01) as risk factors for graft loss. The graft survival death-censored rates were 93.7% and 89% at 1 and 5 years, respectively. Patient survival rates were 97.0% and 94.1% at 1 and 5 years after transplantation, respectively. The long-term graft and patient survival rates in our center are comparable to previous reports from other leading centers. The clinical outcomes from a medium-sized center can be noteworthy, although not entirely new. 

Clinical Outcomes in Living Donor Kidney Transplantation: A Single Center Experience in Latin America.

Background: Jehovah’s Witness refuse blood transfusion, but they accept organ transplantation, albumin, immunoglobulin, vaccines and clotting factors. Clinical cases: We present 3 kidney transplants in Jehovah’s Witness patients (two male and one female) without blood transfusion, with a mean age of 31.33 years and a mean body mass index of 20.99 kg/m2. All patients underwent pre transplant peritoneal dialysis for an average of 52.3 months. Two transplants came from living donors and one from deceased donor with a cold ischemia of 23 hours. The donors were two females and one male, with a mean age of 34.33 years. All patients received pre transplant erythropoietin and iron dextran and an intraoperative cell saver were used. Hemoglobin, hematocrit, red blood cells and serum creatinine levels, as well as the glomerular filtration at 24 months postransplant were stable. All patients received induction with basiliximab and initial immunosuppression with calcineurin inhibitors. One of the patients had a peri renal hematoma as a complication, which required a surgery 20 days post-transplant. At 5, 26 and 36 months postransplant the three patients are alive and with functional graft. Conclusion: It is possible to perform kidney transplantation without transfusion in Jehovah’s Witness, obtaining an acceptable global survival without acute rejection.

/pdf/experiencia-en-trasplante-renal-sin-transfusion-sanguinea-en-398a6slgmp.pdf

Experiencia en trasplante renal sin transfusión sanguínea en Testigos de Jehová, primera comunicación en México

Introduccion: El trasplante renal es la mejor terapia para la mayoria de los pacientes con insuficiencia renal cronica terminal. En el Hospital Regional de Alta Especialidad de Veracruz, el Comite de Procuracion de Organos inicio sus trabajos el 1 de agosto del 2005 y el programa de trasplante renal el 21 de septiembre del 2006. Objetivo: Describir la experiencia del programa de trasplante renal de nuestro hospital, enfatizando en la tasa de sobrevivencia injerto/ paciente. Material y metodos: Estudio retrospectivo de trasplantes renales realizados en nuestro hospital del 21 de septiembre del 2006 al presente. Se registraron variables sociodemograficas relacionadas con trasplante, estatus serologico de citomegalovirus, complicaciones, induccion e inmunosupresion inicial y actual. Se evaluo la tasa de rechazo agudo, funcion renal, numero y tipo de infecciones, causas de muerte y perdida del injerto. La sobrevivencia del paciente y del injerto no censurada al ano 1, 3 y 5 postrasplante fue calculada mediante Kaplan-Meier (log-rango). Resultados: Se realizaron 79 trasplantes, 35 de donante vivo y 44 de fallecido. La sobrevivencia global del paciente fue de 94.9, 93.4 y 82.3% a 1, 3 y 5 anos, respectiva ente. La sobrevivencia global del injerto fue de 87.6, 79.7 y 61.5% a 1, 3 y 5 anos, respectivamente. Las infecciones disminuyeron la sobrevivencia global significativamente. Conclusion: Es posible tener un programa de trasplante predominantemente de donante fallecido con buenos resultados a corto y ABSTRACT

/pdf/experiencia-a-largo-plazo-del-programa-de-trasplante-renal-53b46hjabc.pdf

Experiencia a largo plazo del programa de trasplante renal del Hospital Regional de Veracruz, México

Introduction: Cytomegalovirus is a herpes virus which causes infections in 30-80% of patients with a transplant organ. There are categories of risk in patients undergoing transplantation in relation to cytomegalovirus. Two strate- gies are used to prevent cytomegalovirus: universal prophy- laxis and preemptive therapy. The aim of this study was to determine through a survey, the opinion of cytomegalovirus prophylaxis in the transplant community in our country. Methods: Survey applied during the XVI Congress of the National Society of Transplantation (26-29 September 2012) to health professionals in transplantation and members of Mexican Society of Transplantation. Results: We collected 83 surveys. The average age of respondents was 41 years, 54% were men. 42% percent of respondents have a surgical specialty related to transplantation and 31% a clinical spe- cialty. The largest number came from the Distrito Federal (21.7%) with presence of 19 Mexican states. 66.3% had ex- perience with the disease and 59% have a manual of pro- cedures for it. The transplant more likely to suffer from cytomegalovirus was deceased donor transplants (63.9%) and the high-risk group (D+/R-) is the most frequently in their centers. The universal prophylaxis is more common than preemptive therapy and the preferred scheme is 100 days of valganciclovir (37.3%). Conclusions: Exercises like this survey reveal important information nationally about the infection/cytomegalovirus disease. Prophylaxis schemes should be reviewed according to current international con- sensus (200 days).

/pdf/encuesta-nacional-sobre-profilaxis-de-citomegalovirus-en-el-59m5s3nbvs.pdf

Encuesta Nacional sobre profilaxis de citomegalovirus en el trasplante de órganos

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Experiencia en trasplante renal sin transfusión sanguínea en Testigos de Jehová, primera comunicación en México

Experiencia a largo plazo del programa de trasplante renal del Hospital Regional de Veracruz, México

Encuesta Nacional sobre profilaxis de citomegalovirus en el trasplante de órganos