{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:55:12Z","timestamp":1785779712693,"version":"3.56.0"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008900","name":"University of South Florida","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008900","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Combined heart\u2010liver transplantation (CHLT) represents an infrequent and highly intricate surgical intervention characterized by substantial risk. While isolated cases documenting bloodless heart transplantation or transfusion\u2010free liver transplantation exist, a successful bloodless CHLT had not previously been recorded. This case report details the inaugural instance of such a procedure performed for a Jehovah's Witness patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 67\u2010year\u2010old male Jehovah's Witness with severe multi\u2010vessel coronary artery disease and refractory angina, heart failure with preserved ejection fraction, and metabolic dysfunction\u2010associated steatohepatitis (MASH)\u2010related cirrhosis (stage III\u2013IV) was admitted for transplant evaluation at Tampa General Hospital. Listed as UNOS Status 2e, he underwent bloodless CHLT. Preoperative hemoglobin was 15\u00a0g\/dL, and platelet count was 157\u00a0000\/\u00b5L, optimized with erythropoietin and iron supplementation. Intraoperative blood conservation strategies included meticulous surgical techniques, acute normovolemic hemodilution (ANH, two units), cell salvage (675\u00a0mL), cryoprecipitate (600\u00a0mL), aminocaproic acid, and FEIBA (factor eight inhibitor bypassing activity). Both transplantations were uneventful. The patient was extubated on postoperative day 1 (POD 1). Endomyocardial biopsy on POD 16 showed no rejection. An echocardiogram on POD 18 confirmed preserved biventricular function (LVEF 60\u201365%). The patient was discharged on POD 24 with hemoglobin of 9.6\u00a0g\/dL and platelet count of 227\u00a0000\/\u00b5L. At POD 60, he exhibited excellent function of both transplanted organs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This report expands the scope of bloodless medicine, offering a model for managing complex multi\u2010organ transplants in patients with religious restrictions to blood products, with the patient continuing to exhibit excellent recovery approximately ten months post\u2010transplant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70592","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:12:31Z","timestamp":1781251951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First Successful Bloodless Combined Heart\u2010Liver Transplantation in a Jehovah's Witness"],"prefix":"10.1111","volume":"40","author":[{"given":"Chamanthi","family":"Konidala","sequence":"first","affiliation":[{"name":"University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Balazs","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Hill","sequence":"additional","affiliation":[{"name":"Anesthesia TeamHealth  Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanjina","family":"Jalil","sequence":"additional","affiliation":[{"name":"Anesthesia TeamHealth  Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gundars","family":"Katlaps","sequence":"additional","affiliation":[{"name":"Department of Surgery University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Dhanireddy","sequence":"additional","affiliation":[{"name":"Department of Surgery University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elia","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Camporesi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of South Florida Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000002549"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2021.0103"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871\u2010020\u20100945\u2010x"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.04.006"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.70277"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001155"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.09.121"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14155444"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001065"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2020.1859102"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.25259\/JCCC_24S1_NW"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2021.03.014"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70592","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70592","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:25:06Z","timestamp":1785777906000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":12,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/ctr.70592"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70592","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70592"}}