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Transfusion Service

(P-TS-109) Transfusion Support In Xenotransplantation

Sunday, October 20, 2024
12:00 PM - 1:00 PM  
Background/Case Studies: Xenotransplantation, the implantation of an animal’s organ into a human, has long been proposed as a solution to donor organ shortages. Because the human immune system rejects foreign tissue, modifications have been made to animal genes to make the organs more compatible. Our institution transplanted a kidney from a genetically modified pig to a man declared dead by neurologic criteria. From the Blood Bank perspective, there are no current guidelines regarding transfusion indications or modifications required for this population. We share our experience in providing transfusion support for this decedent over the duration of the two-month study. 

Study

Design/Methods:

We coordinated transfusion needs and product availability with the xenotransplant research team and blood suppliers.

Results/Findings: The decedent was a 57-year-old man who was declared dead by neurologic criteria due to a grade 4 glioblastoma multiforme and underwent a thymokidney xenotransplant and bilateral native nephrectomy. He was maintained on a ventilator and monitored throughout the study. Ten xenokidney biopsies were performed. The patient underwent two courses of plasma exchange, on post-operative days 34/36/38/40/42 and 50/52/53/58, based on renal function studies and biopsy results. The experiment was terminated and the xenokidney was explanted on day sixty-one. The decedent had no cardiac history but was maintained on somatic support and frequently phlebotomized for research purposes. Red blood cell (RBC) pre- and post-washing segments, fresh frozen plasma (FFP) segments and cryoprecipitate segments were provided to the xenotransplant research team for xenoantibody testing. RBCs and cryoprecipitate were tested retrospectively. RBCs were transfused to maintain a hemoglobin >7 g/dL and were CMV negative, irradiated, and washed to avoid the passive transmission of xenoantibodies. Washed RBCs were available from our blood supplier within 4 to 6 hours of ordering. Cryoprecipitate was transfused to maintain a fibrinogen >100 g/dL and was later avoided after retrospectively being found to contain high levels of xenoantibodies. FFP was screened for xenoantibodies prior to transfusion, and low titer units were selected for transfusion. FFP was transfused as part of replacement fluid during plasma exchange. In total, the patient received 25 units of RBCs, 19 units of plasma, and 3 units of cryoprecipitate over the two-month period. 

Conclusions: As xenotransplantation is a new area of investigation in kidney transplant, there is no literature on transfusion practices in this population. Our case highlights the feasibility of supporting patients undergoing xenotransplantation and helps outline considerations for transfusion indications and modifications for prospective cases.