Despite waning indications in the general population for preoperative autologous blood donation (PABD), it is a procedure that continues to be offered to healthy living liver donor (LLD). In this study, we sought to understand the impact of PABD on the LLD population.
We retrospectively reviewed charts of one institution's LLDs over a 2-year period. Per institutional protocol, all accepted LLDs donated 1 unit of autologous blood before living donor hepatectomy.
Sixty-six LLDs underwent PABD and 59 of these donors underwent living donor hepatectomy. In this cohort, there was a significant 1.2 g/dL drop in hemoglobin (HB) from baseline (before PABD) to the evening before surgery. Mean (standard deviation [SD]) procedure estimated blood loss was 260 mL (±100), mean (SD) resected graft weight was 592 g (±174). No allogeneic blood was transfused. Forty-two percent of LLD received autologous transfusion. Mean (SD) pretransfusion HB of transfused LLDs was 11.7 g/dL (±1.2). All LLDs had negative antibody screens. Sixty-three percent of donated autologous units were discarded.
Preoperative autologous blood donation in our population is associated with decreased preoperative HB, increased exposure of healthy LLD to unnecessary transfusion-related risks and high rates of discarded blood product. We encourage further investigation and reconsideration of the practice of PABD and autologous transfusion in LLDs.
The authors propose compelling evidence that autologous blood collection offers little benefit in living liver donation.
1 Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco, CA.
2 Division of Transplant Surgery, Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA.
3 Department of Laboratory Medicine, University of California San Francisco School of Medicine, San Francisco, CA.
Received 12 April 2018. Revision received 23 May 2018.
Accepted 17 June 2018.
Support received from our own academic departments only: no external funding.
The authors declare no conflicts of interest.
S.M. participated in research design, collection of data, statistical analysis, and article writing and preparation. J.R. participated in review of data, article preparation, and review. S.B. participated in research design, collection of data, data analysis, and article writing and preparation.
Correspondence: Solmaz Poorsattar Manuel, MD, Department of Anesthesia and Perioperative Care, University of California San Francisco, 4th Floor, 500 Box 0648 Parnassus Ave, MU West, San Francisco, CA 94143. (Solmaz.Manuel@ucsf.edu).