Bolcato Matteo, Fava Ludovico, Shander Aryeh, Zenger Christoph, Trentino Kevin M, Chisari Mario, Agostini Vanessa, Beverina Ivo, Biancofiore Giandomenico Luigi, De Angelis Vincenzo
Department of Medicine, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy.
MESIT Foundation of Social Medicine and Innovation Tecnology, 00131 Rome, Italy.
J Clin Med. 2025 Aug 1;14(15):5444. doi: 10.3390/jcm14155444.
: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the "extreme" application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. : A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. : Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney-pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. : The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams.
患者血液管理（PBM）策略已被证明能显著减少血液制品的使用，并使外科手术能够在无需输血的情况下安全进行。这一证据引发了关于PBM策略在复杂外科手术（如器官移植）中“极端”应用可能性的问题，即使是在无法进行输血的患者中。本范围综述的目的是识别和描述医学文献中关于四种主要实体器官（肾脏、心脏、肝脏和肺）在拒绝输血患者中的移植的现有证据。
使用PubMed对2000年1月至2025年2月的文献进行了全面检索。仅纳入报告病例、病例系列、人群样本或描述不使用血液成分的实体器官移植的比较研究的文章。结果针对每个实体器官分别呈现。
纳入了9项研究，其中7项报告了肾脏或肾胰腺移植的病例报告或病例系列，2篇文章为比较研究。
9项研究报告了无输血肝脏移植，8项为病例报告或病例系列，1项为比较观察性研究。
纳入了5项研究，其中4项是心脏移植的病例报告；此外还有一项比较研究，描述了8例不使用血液成分的心脏移植与16例可输血移植患者的情况。
报告了5项无输血肺移植的研究，其中4项是在无死亡情况下进行的病例报告，2项为双侧移植。此外，有一篇文章描述了2例不使用血液成分的单肺移植与10例可输血移植患者的情况。
所进行的分析表明，根据器官不同，经验丰富的多学科团队在经过精心挑选和准备的患者中有可能在不使用血液成分的情况下进行实体器官移植手术。
