What strategies could reduce the use of blood transfusions in certain surgical contexts, particularly in liver transplants? This is one of the questions that Dr. François Martin Carrier is attempting to answer as the holder of the Héma-Québec–Bayer Chair in Transfusion Medicine, Université de Montreal.

Dr. Carrier has had an atypical career path. First, he was a clinician: an anesthesiologist and intensivist specializing in liver diseases at the CHUM for seven years before starting his research career in 2018. His path has been an asset, allowing him to identify certain gaps in his practice and motivating him to continue his studies to become a researcher.

“Liver transplants have always fascinated me,” he remarks, enthusiastically. “It is an important operation, performed on patients who are very ill and who require intensive care. During my residency, it was normal to hear that the days were numbered for a cirrhotic patient when they were admitted to intensive care. I found that there wasn’t a lot of clinical expertise in this field, so I decided to delve deeper into these issues with the goal of improving patients’ trajectories.”

An overused practice?

As Dr. Carrier points out, blood transfusion saves countless lives, but it can involve complications for certain people. The presence of water in the lungs, increased risk of infection and destabilization of the immune system are among the side effects that can increase risks of complication. However, it is not clear whether these effects occur because the individual receiving the transfusion is already ill or if they are partially caused by the transfusions themselves. In rare cases, incompatibility leading to the destruction of red blood cells has been observed. 

In addition to these potential complications, there are challenges associated with prolonged hospital stays, high costs of transfusions and the risk of blood shortages, which sometimes leads to cancelling surgeries that require transfusions. “If we can better understand the mechanisms at play, we will have a means of raising awareness among clinicians to reduce unnecessary transfusions for patients. “I think this will help make our health care system more resilient,” says Dr. Carrier. 

Promising studies

To try to elucidate these questions, among others, Dr. Carrier and his team undertook a multicentre cohort study involving 850 patients who underwent liver transplants at eight transplant centres, six in Canada and two in France. Data was collected throughout the year and its ongoing analysis will, among other things, establish links between transfusions and patients’ clinical conditions, ultimately aiming to reduce the use of blood and to implement optimal care processes.

In parallel with this incredible achievement, a few months ago Carrier also launched a multicentre randomized clinical trial on liver transplants, comparing the results of two intraoperative hemodynamic management strategies performed on Canadian patients to determine if one of them helps reduce bleeding, transfusions and postoperative complications. This study is being conducted in collaboration with three hospitals to start with—the CHUM, the London Health Sciences Center and the MUHC—but others will be included throughout the trial, possibly in France.

Other projects on transfusion risks affecting different patient profiles in surgery are in the launch phase, notably thanks to the support of the CITADEL platform (CHUM’s Centre for the Integration and Analysis of Medical Data).

This portrait is taken from our 2023-2024 Activity Report