Autologous Blood Transfusion During Elective Surgery in a Candidate for Living Donor Transplantation: A Case Report

Abstract

Blood transfusions are risk factors for alloimmunization and unfavorable outcomes in solid organ transplant recipients. We propose the adoption of autologous blood transfusion (ABT) in transplant candidates and recipients referred to elective surgery. We present a case of a 45-year-old man with chronic kidney disease stage 5 due to polycystic kidney disease, who was qualified for a native kidney nephrectomy (NKN) before kidney transplantation. Before the scheduled surgery, the patient was referred to a blood donation center for blood collection. During 2 consecutive visits, autologous blood was collected uneventfully, and this allowed for the preparation of 2 units of red blood cell concentrates and a unit of plasma. Pre- and post-donation hemoglobin values were 11.9 and 10.4 g/dL, respectively. The NKN procedure was complicated by intra-abdominal bleeding from an accessory aberrant artery of the kidney. Hemoglobin dropped to 6.8 g/dL and was treated with ABT, followed by artery embolization. This allowed for an increase of hemoglobin to 8.3 mg/dL and avoidance of allotransfusion. Six weeks after NKN, the patient underwent successful kidney transplantation from a living donor. Panel reactive antibodies before transplantation were 0%, and graft function has been excellent during 20 months of observation. An autologous blood collection is a feasible option for patients with chronic kidney disease. ABT should be considered the procedure of choice when qualifying potential waiting list candidates and solid organ recipients for elective surgeries.