INSTITUTIONAL VARIATION IN HEMOTHERAPY FOR SOLID-ORGAN TRANSPLANTATION

Background: Solid organ allograft recipients may require large amounts of blood components. The modification of components to make them safe r for iatrogenically immunosuppressed transplant patients increases wo rkload demands on blood banks and transfusion services. Study Design A nd Methods: Institutions within the United States and Canada providing hemotherapy as support for transplant recipients were surveyed for th eir transfusion practices. Results: Responses from 25 institutions pro vide the data for this report. In 1991, the mean intraoperative red ce ll requirements ranged from <1 unit for renal allograft recipients to 17.3 units for liver transplant recipients. The latter group also requ ired the greatest amounts of platelets, fresh-frozen plasma, and cryop recipitate. More than 75 percent of responding institutions provided e ither cytomegalovirus-seronegative or white cell-reduced cellular comp onents to pediatric recipients of liver allografts and to both adult a nd pediatric recipients of heart, lung, and heart-lung all lografts. T he use of irradiated cellular blood components, although uncommon, was greatest in heart transplant recipients. The use of pretransplantatio n transfusions for immunomodulation was generally limited to patients awaiting a living-donor renal transplant. Conclusion: Transfusion prac tices varied among the institutions, but the majority provide cytomega lovirus-safe cellular blood components to heart and lung allograft rec ipients and to pediatric transplant patients. Gamma-radiated cellular components are not routinely provided to patients undergoing solid org an transplantation. Liver allograft recipients require the greatest am ount of hemotherapeutic support.