Preoperative autologous blood collection in adult living liver donors: Are we wasting donor blood and increasing exposure to risk?

Background 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 donors (LLD). In this study we sought to understand the impact of PABD on the LLD population. Methods We retrospectively reviewed charts of one institution's LLDs over a 2-year period. Per institutional protocol, all accepted LLD donated 1 unit of autologous blood prior to living donor hepatectomy (LDH). Results Sixty-six LLDs underwent PABD and 59 of these donors underwent LDH. In this cohort, there was a significant 1.2 g/dL drop in HB from baseline (prior to PABD) to the evening before surgery. Mean (SD) procedure estimated blood loss was 260 mL (±100), mean (SD) resected graft weight was 592 g (±174). No allogeneic blood was transfused. 42% 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. 63% of donated autologous units were discarded. Conclusions PABD 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. Received 12 April 2018. Revision received 23 May 2018. Accepted 17 June 2018. Corresponding author: Solmaz P. Manuel, M.D., Department of Anesthesia and Perioperative Care, University of California San Francisco, 500 Parnassus Avenue, MU West 4th Floor, Box 0648, San Francisco, CA 94143. Phn: (415) 476-9043. Solmaz.Manuel@ucsf.edu AUTHORSHIP Solmaz Manuel: Participated in research design, collection of data, statistical analysis, and manuscript writing and preparation. John Roberts: Participated in review of data, manuscript preparation and review. Sara Bakhtary: Participated in research design, collection of data, data analysis, and manuscript writing and preparation. Disclosure: The authors declare no conflicts of interest. Funding: Support received from our own academic departments only: no external funding. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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