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Long-Term Survival Following Transfusion-Free Heart Transplantation In Jehovah's Witnesses
*Andrew C W Baldwin1,2, *Mehmet H Akay3, *Rajko Radovancevic3, *J Michael Duncan2, *Whitson B Etheridge2, *Denton A Cooley2, *O H Frazier2
1Yale School of Medicine, New Haven, CT;2Texas Heart Institute, Houston, TX;3Memorial Hermann Heart and Vascular Institute, Houston, TX
Objective: Due to the doctrinal refusal of blood transfusions, members of the Jehovah’s Witness (JW) faith present a considerable challenge within the field of cardiac surgery. Many centers decline to offer transplant listing to JW followers due to the risk of significant blood loss. We present the largest reported series of JW patients to undergo heart transplantation.
Design: Case series.
Setting: Academic tertiary referral center.
Patients: Sixteen JW patients underwent transfusion-free cardiac transplantation at our institution over a 27-year period (14 men, 2 women; age 40±11 years). Each patient underwent a preoperative optimization strategy consisting of iron supplementation, minimization of phlebotomy, and recombinant human erythropoietin.
Interventions: n/a
Main Outcome Measure: Changes in total blood volume were assessed through comparison of pre- and postoperative hemoglobin levels, along with relevant clinical parameters from the immediate postoperative period. Long-term outcomes were evaluated using evidence of graft rejection and overall survival.
Results: Laboratory studies demonstrated an average preoperative hemoglobin level of 12.7±1.9 g/dL, dropping to 10.8±1.8 g/dL immediately after surgery and 10.3±1.8 g/dL upon discharge. Two patients died during the initial hospital stay–1 due to bleeding complications, and the second as the result of a ventricular arrhythmia. The remaining 14 patients were discharged home and managed using marrow-sparing immunosuppressive therapy. Endomyocardial biopsy testing revealed evidence of cellular rejection in only 1 patient. The overall postoperative survival was 3529±3675 days (range 2-9109 days). Six patients are still alive, with a mean survival of 19.9±7.7 years (range 4-24 years).
Conclusions: Transfusion-free heart transplantation is a feasible and valuable option for selected JW patients with end-stage heart failure. Candidates managed with blood-conserving techniques experience outcomes comparable to those of traditional transplant recipients.
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