A 13% incidence of pressure sores quoted by Dr. Sharon is much higher than we see in our liver transplant population. In the past 8 yr, this is the only case of skin injury documented in our liver transplant patients. The skin injury that our patient developed had the imprint of the water-warming device on it, removing any doubt that the warmer was involved in the injury. The occurrence of this injury despite proper placement and functioning of the device suggests that adjustments to the Allon system may be necessary.

It is true that our patient had risk factors predisposing her to skin injury, but we were concerned about temperature maintenance because of these factors. If she had been healthy and well nourished, she would have been less likely to need a device to help maintain her body temperature. With regard to the pressure relief algorithm, the only information that we could find is one unpublished trial of three patients, which revealed pressures of up to 200 mmHg (measurement limited because of 200 mmHg as the maximum range of calibration).

Although the Allon system may help maintain normothermia, it may do so at some risk to patient well-being.