Delayed adverse reactions in whole blood donors: Importance of active surveillance in identifying the missing gaps in the donor safety

Background & objectives: The information available regarding delayed adverse donor reactions (D-ADRs) is limited. Proactive follow up of donors for delayed reactions is not done routinely. This study was undertaken to analyze frequency and type of D-ADRs in whole blood donors as also the contributory factors. Methods: In this prospective observational study, all eligible whole blood donors were contacted telephonically twice (24 h and 2 wks after donation) and asked about general health and ADR specific questions. The International Society of Blood Transfusion standard guidelines were used to categorize ADRs. Results: The ADR data of 3514 donors were analyzed in the study. D-ADRs were more common as compared to immediate delayed adverse donor reactions (I-ADRs) (13.7 vs. 2.9%, P<0.001). The most common D-ADRs were bruises (4.98%), fatigue or generalized weakness (4.24%) and sore arms (2.25%). D-ADRs were more common in first time donors as compared to the repeat blood donors (16.1 vs. 12.5%, P=0.002). Females were more prone to D-ADRs (17 vs. 13.6%). Localized D-ADRs were more frequent as compared to systemic D-ADRs (P<0.001). Repeat donors had a lower incidence of systemic D-ADRs (4.11% vs. 7.37%, P<0.001). Interpretation & conclusions: D-ADRs were more common than I-ADRs with a different profile. First time, female and young donors were more prone to D-ADRs. These categories need special care at the time of blood donation. Active follow up of blood donors should be done from time to time to strengthen donor safety

Surgical Outcomes and Complications after Right Hepatectomy in Living Donation for Adult Liver Transplantation: Single Center Experiences from 245 Cases / 대한이식학회지

BACKGROUND: As the necessity of adult living donor liver transplantation continues to increase, morbidity and mortality of donors has been considered vital. Thus, we performed a sequential analysis of our surgical experience in order to find ways to improve surgical outcomes in right liver donors. METHODS: We performed a retrospective sequential analysis of surgical outcomes of consecutive 245 right liver donors by 50 cases between October 2002 and November 2012. RESULTS: Hospital stay (13.78 to 10.98 days), operation time (432.76 to 389.98 minutes), amount of intra operative bleeding (577.70 to 502.56 mL), and perioperative transfusion rates decreased from the initial 50 cases to the last 45 cases. A total of 96 grade I complications by Clavien-Dindo classification decreased from 26 to 17. Ten and three cases had grade IIIa and IIIb complications, respectively. There were three cases of wound infection, two cases of duodenal ulcer bleeding, one case of pleural effusion, and four cases of bile leakage of grade IIIa complications, and one case of postoperative intestinal obstruction, one case of generalized peritonitis by small bowel perforation, and one case of bile leakage of grade IIIb complications. There was no mortality during the follow-up period. CONCLUSIONS: Although most complications with low-grade severity might be corrected by surgical refinement, efforts to reduce possible moderate to severe complications should be sustained.

Review and prospects on research and application of hematopoietic stem cell transplantation / 白血病·淋巴瘤

The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been improved over past 50 years due to the advances in HLA matching and increasing sources of HSC donors,such as developments and progressions of HLA-matched sibling donor transplantation (MSDT),umbilical cord transplantation (UCBT/CBT),unrelative donor transplantation (URDT),and HLA haploidentical transplantation (haplo-SCT).To review and discuss progressions in field of allo-HSCT,we studied relative advances reports of Education Program Book,54th-ASH,2012.Howeover,the outcomes of allo-HSCT can be quite different according to different diseases,disease phase or patient age.Furthermore,according to our local experiences,we emphasize again significance of HSCT donor safety.

Significant reduction in hematological values after plateletpharesis: clinical implication to the donor.

Background: Plateletpheresis procedures are thought to be generally safe without serious complications to the donor, and the products obtained are preferred over platelets derived from whole blood. However, safety issues about the donors have not been fully explored. Objective: Investigate changes in hematological values after plateletpheresis in healthy volunteer donors. Methods: A retrospective study was performed in 76 healthy donors at the Transfusion Medicine Unit, Universiti Sains Malaysia between 2004 and 2009. Haemonetics MCS+ and Trima accel (Gambro BCT) separators were used during plateletpheresis. Pre- and post-donation hematological values such as Hb, Hct, platelet, and leukocyte counts were measured using Sysmex XE-2100. Results: After each procedure, there was a significant reduction in hemoglobin (pre-donation: 14.9g/dl, postdonation: 14.7g/dL), hematocrit (pre-donation: 44.6%, post-donation: 44.1%), platelet count (pre-donation: 264.0x109/L, post-donation: 193.4x109/L), mean platelet volume (pre-donation: 10.0fL, post-donation: 9.7fL), and platelet distribution width (pre-donation: 12.3fL, post-donation: 11.8fL). Conclusion: There were significant drops in the donors hematological values post plateletpheresis.

Current Status and Perspectives of Living Donor Liver Transplantation

Living donor liver transplantation (LDLT) has been an established treatment modality for patients with end- stage liver diseases, especially in countries with scarcity of deceased donors. The annual number of LDLT cases in Korea has been steeply increasing, exceeding that of Japan and even doubling that of United States in 2007. When comparing LDLT and deceased donor liver transplantation (DDLT), the timely availability and quality of liver grafts are superior in LDLT, but there are definite drawbacks from anatomical sharing of 1 liver organ by 2 individuals as well as potential donor risk. Biliary complications seem to be the most intractable problems following adult LDLT. The indications for LDLT are nearly identical to those of DDLT. The optimal timing for performing LDLT is not clearly defined, but an earlier transplantation is often recommended before serious worsening of general conditions. The post - transplant management following LDLT is often more difficult than that of DDLT although early liver regeneration makes the liver graft large enough. Current situation in Korea requires a heavy demand on DDLT, but it is still very difficult to expect a rapid rise of deceased donor number within a few years. Thus, LDLT may continue to play the pivotal role to compensate for the serious shortage of deceased donor organs. Coercion to living donors should be prohibited in any situation. The medical team and our whole society should pay special attention to caring of living donors in order to encourage organ donation.

Evaluation of the Double Plateletpheresis Using Cell Separators for Korean Blood Donors / 대한수혈학회지

BACKGROUND: To evaluate the safety of double plateletpheresis which has already become established among developed countries and to set the guidelines for the donor selection and the deferral period between blood donations for Korean blood donors METHODS: From October to November, 2003, double plateletphereses were done in 28 voluntary donors whose platelet counts were more than 200,000/microliter at the KRC Cenral, Nambu, and Dongbu blood centers. During the collection the citrate reaction and the collection time were recorded and regular cell counts were done after the collection to assess the recovery. The platelet count, pH test, and blood culture were done in all the collected platelets. RESULTS: The mean total processing volume was 4,312mL and the mean volume of the anticoagulant infused to donor was 373 mL. The average collection time was 97 minutes. Most donors complained 'slight' citrate reaction during procedures and felt the procedures 'a little boring' because of the long collection time. The platelet count counted immediately after procedures was decreased by 35.9% on the average and it took 14 days for 95% of donors to recover the 95% level of the original platelet count. The mean product volume was 501 mL and the mean platelet yield of products was 6.4 x 10 11 platelets. The pH measured at fifth day after collection was 7.3 and no aerobic bacteria was found in the culture. CONCLUSION: No significant adverse reaction was found in double plateletpheresis for Korean blood donors as compared with the existing one dose plateletpheresis. The guidelines for donor selection should include the minimum platelet count requirement with more than 200,000/microliter and the deferral period between donations should be or more 14 days.

Donor Quality of Life in Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: The safety of donors and the impact on quality of life (QOL) was the most important thing in living donor liver transplantation (LDLT). METHODS: Questionnaires were sent to 50 donors who were followed up more than 4 months after LDLT from December 2001 to January 2003 (response rate 92.0%). The control group was selected the same number of the general public (n=42). The questionnaire consisted of donors characteristics, medical and psychosocial outcomes, and global QOL (KHP 1.0). Follow-up investigations were also performed at out patient clinic 1, 4, and 12 months after discharge. RESULTS: The donors were more prevalent in male patient (63.0%) and most common in twenties (23.8%). The relations to the recipients were 17 offsprings (37.0%), 12 parents (26.1%), 6 spouses (13.0%), and et cetera. There was no perioperative transfusion, reoperation, and none of the donors died or has suffered life-threatening complications. Average length of hospital stay is 11.4+/-4.5 days. The mean recovery time was 1~3 months in a half of them. All donors resumed their predonation occupation or regular activity and felt no limitation. Most donors were satisfied with their donation (95.6%) and their current life (87.0%) after operation. The score of QOL examined by KHP 1.0 showed that physica role of donors were more restricted but emotional health was better than that of the general public. CONCLUSIONS: Most donors in LDLT felt it to be good, but some limitation ofl their physical role despite of their physical recoveries. Donor follow-up needs to be emphasized and followed more systemically.

Donor Safety in Living Donor Liver Transplantation Using Right Lobe / 대한이식학회지

PURPOSE: Right lobe donation is technically more difficult and need to define surgical technique and has more risk for surgical complication. Right lobe donation usually matched graft size but safety of donor is major concern. In this paper, we reviewed our experience of donor hepatectomy using right lobe in regarding to safe of our donor operations, retrospectively. METHODS: Retrospective analysis of 42 donor operations for adult LDLT using right lobe was performed. We observed the patient characteristics, the operative findings, peak liver enzymes (AST, ALT, bilirubin) as donor risk and mortality, morbidity. RESULTS: The peak value of liver enzymes in the group of less the 30% of remained liver were significantly higher than the group of more than 30% of remained liver and these values could induced the risk on donor. The postoperative peak value of liver enzymes were increased according to degree of fatty change especially in case of more than 10% fatty change even without significance. We observed the liver regeneration on postoperative 3 months and the regeneration of liver volume on postoperative 3 months was about two times compare to preoperative value and the regenerative activity was more increased in the group of less amount of remained volume. There was no donor mortality and most important complication was biliary complication, in which were biliary injury, bile leakage and biliary stricture. CONCLUSION: Right lobectomy for donor operation requires a meticulous surgical technique to minimize donor morbidity. Right lobectomy can be performed safely with minimal risk in case of careful donor selection that the remained liver volume exceed 30% of the total liver volume and the liver of minimal fatty change.