Intraoperative irradiation of transfused red blood cells during living donor liver transplantation using a portion of the liver

Abstract

Aim. To study the results of intraoperative irradiation of transfused erythrocytes during liver donor liver transplantation. To describe a clinical case of the intraoperatively irradiated erythrocyte use during liver donor liver transplantation in a patient with hepatocellular carcinoma and to evaluate the effectiveness of this approach in reducing postoperative complications.

Materials and methods. In this clinical case, a part of the liver was transplanted to the patient with hepatocellular carcinoma. During surgery, in order to avoid complications from massive whole blood transfusion, autologous erythrocyte mass was used after previous washing using a cell-saver machine and irradiation with a dose of 50 Gy performed on a linear accelerator.

Results. There were neither signs of acute respiratory failure, nor use of oxygen or continuous positive airway pressure therapy in the postoperative period. No indications for transfusion of foreign red blood cells were found as well as no signs of graft dysfunction were noted in the early postoperative period. The highest level of liver markers was observed laboratory in the late postoperative period.

Conclusions. The use of intraoperatively irradiated transfused red blood cells in liver transplantation for the recipient with hepatocellular carcinoma allowed for the prevention of postoperative complications associated with massive foreign blood transfusion such as acute respiratory failure or transfusion-related acute lung injury and early graft dysfunction. An optimal radiation dose is 50 Gy as a compromise between the need to ensure complete inactivation of tumor cells and preserve the functional properties of erythrocytes.