(P-TS-85) Providing Blood Products for Normothermic Perfusion Techniques to Facilitate Organ Transplant: Implementation and Utilization at a Single Center

Normothermic regional (NRP) and machine (NMP) perfusion are organ procurement and transport techniques that can improve organ quality, facilitate longer transport, and reduce post-operative complications, overall increasing organ availability and improving outcomes. NRP and NMP often require allogeneic red blood cells (RBCs).  Our academic transfusion service began providing RBCs to support NRP and NMP for adult heart transplant (HT), orthotopic liver transplant (OLT), and multi-organ transplant (MOT) in August 2020.

Study

Design/Methods: This single-center, retrospective study describes the implementation process and analyzes the characteristics of blood product support during the first 3 years of the perfusion programs.  Parameters such as timing and quantity of units issued and used, as well as organ recipient demographics and transplant outcomes, were obtained from transfusion service and electronic medical records.

Results/Findings:

Procedures were developed to supply up to 5 units of group O, D-positive RBCs via emergency issue to a generic patient account (e.g. “UNOS, Heart”) in a portable, battery-powered refrigerator that travels with the organ procurement team. Final disposition of the units is documented, including the organ recipient if the perfused organs were transplanted.

From August 15, 2020 through August 26, 2023, the transfusion service received 233 requests for RBCs to support perfusion, which resulted in 131 organ transplants (92 HT, 27 OLT, and 12 MOT).  On average per request, the transfusion service issued 4.8 units (SD 0.8, range 2-10), the perfusion team utilized 1.5 units (SD 1.9, range 0-7), and 3.1 units were returned to inventory (SD 2.0, range 0-5) (Fig A).  Units were out of the blood bank for an average of 8.7 hours (SD 3.6, range 0.4-21.7). The majority of perfusion-facilitated HTs utilized NRP (81/92, 88%), whereas most perfusion-facilitated OLTs utilized NMP (21/27, 78%). Among organ recipients, 14 had red cell antibodies. No perfusion-related adverse events were reported.  Process modifications over time included supplying up to 10 units to accommodate combined NRP/NMP cases, and providing a refrigerator power cord and applying irreversible temperature indicators to facilitate longer transit and reduce blood wastage. Across all 233 requests, a total of 381 units were used or discarded, and they facilitated 131 transplants, averaging 2.91 units/transplant.

Conclusions: Provision of blood for NRP and NMP techniques represents a novel method for transfusion services to support and facilitate life-saving HT, OLT, and MOT with only modest blood use, about 3 RBC units per transplant recipient in this single-center study.