DP13: FIRST SUCCESSFUL BLOODLESS COMBINED HEART-LIVER TRANSPLANTATION IN A JEHOVAH'S WITNESS
Chamanthi Konidala1; Juan Perrone, MD1; Carlos Miranda, MD1; Balazs Zsolt, MD1; Jenna Hill, CRNA2; Jeffrey Weiss, DO1; Tanjina Jalil, MA2; Gundars Katlaps, MD1; Kiran Dhanireddy, MD1; Elia Elia, MD1; Enrico M Camporesi, MD1
1University of South Florida Morsani College of Medicine; 2TeamHealth Anesthesia, Tampa General Hospital
Background: Combined heart-liver transplantation (CHLT) represents an infrequent and highly intricate surgical intervention characterized by substantial risk. Despite advancements in patient care and procedure, standard CHLT frequently necessitates transfusion of approximately 17.9 units of red blood cells and 14.3 units of fresh frozen plasma2. While isolated cases documenting bloodless heart transplantation3 and transfusion-free liver transplantation exist4, a successful bloodless CHLT had not previously been recorded. This case report details the inaugural instance of such a procedure performed for a Jehovah’s Witness patient.1,5,6,7
Case Presentation: A 67-year-old male Jehovah’s Witness with severe multi-vessel coronary artery disease and refractory angina, heart failure with preserved ejection fraction, and metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis (stage III–IV) was admitted for transplant evaluation at Tampa General Hospital. Listed as UNOS Status 2e, he underwent bloodless CHLT on May 31, 2025. Preoperative hemoglobin was 15 g/dL, and platelet count was 157,000/µL, optimized with erythropoietin and iron supplementation. Intraoperative blood conservation strategies included meticulous surgical techniques, acute normovolemic hemodilution (ANH, two units), cell salvage (675 mL), cryoprecipitate (600 mL), aminocaproic acid, and FEIBA (factor eight inhibitor bypassing activity).
The heart transplantation was completed first, using bi-caval anastomoses. The liver transplantation was accomplished immediately after, using a piggyback technique with a liver preserved with LiverGuard and normothermic perfusion (OrganOx Metra). Both transplantations were uneventful without complications. The patient was extubated on postoperative day (POD) 1. Immunosuppression included mycophenolate mofetil, prednisone, and basiliximab. Early transaminitis suggestive of rejection was managed with methylprednisolone. Endomyocardial biopsy on POD 16 showed no acute cellular or antibody-mediated rejection. An echocardiogram on POD 18 confirmed preserved biventricular function (LVEF 60–65%) with mild-to-moderate tricuspid regurgitation. The patient was discharged on postoperative day 24 with hemoglobin of 9.6 g/dL and platelet count of 227,000/µL. At 60 days post-transplant, he exhibited excellent function of both transplanted organs (See Figure).
Conclusions: This case demonstrates the feasibility of bloodless CHLT in a Jehovah’s Witness using meticulous preoperative, intraoperative, and postoperative blood-conservation techniques. Multidisciplinary coordination ensured excellent graft function and patient outcomes. This report expands the scope of bloodless medicine, offering a model for managing complex multi-organ transplants in patients with religious restrictions to blood products, with the patient continuing to exhibit excellent recovery approximately eight months post-transplant.
Ref
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6. Jabbour N et al. J Am Coll Surg. 2005;201:412–17.
7. Kiani AZ et al. Clin Transplant. 2025;39:e70277.
