(P-TS-81) Multidisciplinary Collaboration Leading to Successful Liver Transplantation for a Hemophilia B Patient with HIV, HCV and Multiple RBC Alloantibodies

Background/Case Studies: A multidisciplinary approach was needed to meet the challenge of providing support for a liver transplant candidate with a history of Hemophilia B, HIV, HCV, end stage liver disease who formed multiple RBC alloantibodies.

Study

Design/Methods: A review of the patient’s history showed that the patient acquired HIV and HCV infections back in the 1980’s and 1990’s due to repeated episodes of bleeding leading to multiple infusions of plasma-derived Factor IX concentrates and RBC transfusions. Now he developed end stage liver disease from the HCV and HIV infections and came to our hospital for advanced care and liver transplant evaluation. Blood Bank workup showed that he was B Negative with Anti-K at the first admission. Within a year, he developed multiple alloantibodies which provided additional challenges to liver transplant.

Patient's alloantibody development history and transfusion events are detailed in Table 1.

After the patient was listed as a liver transplant candidate, a multidisciplinary team including transplant surgery, transplant hepatology, hematology, transfusion medicine, coagulation testing lab formed to provide a comprehensive plan for the patient’s liver transplant and maintain communication about any changes to the plan. Hematology team would optimize Factor IX supplement to minimize bleeding and transfusion needs leading up to transplant. On the day of surgery, they would provide Factor IX to bring his level to 60% which would be high enough to decrease his bleeding risk during surgery but also reduce the risk of hepatic vein thrombosis. Blood Bank requested antigen negative RBC units from the donor blood center and would reserve and maintain 25 K, C, D and Jka antigen negative RBC units in inventory for the patient. Transplant team would use the Organ Care System to maintain the donor liver and allow surgery to occur during day hours. Upon acceptance of the donor liver, the entire team would be notified and mobilized by transplant coordinator.

Results/Findings: The patient was successfully transplanted with a new liver in a 3 ½ hour surgery. He received 5 RBCs, 8 FFP and 5 pools of cryoprecipitate during the transplant. Postoperatively, his Hemophilia B was cured.

Conclusions: For extremely challenging liver transplant cases, a multidisciplinary collaboration care team approach is the key to success. The team provides their expertise to form a comprehensive individualized care plan for each patient. Continued communication within the team is essential.