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World J Gastroenterol. Jun 14, 2013; 19(22): 3371-3374
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3371
Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients
Bo Zhai, Xue-Ying Sun
Bo Zhai, Xue-Ying Sun, Hepatosplenic Surgery Center, Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Author contributions: Sun XY conceived and revised the article; Zhai B searched the literature and drafted the manuscript.
Correspondence to: Xue-Ying Sun, MD, PhD, Professor, Hepatosplenic Surgery Center, Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China. kevsun88@hotmail.com
Telephone: +86-451-53643628 Fax: +86-451-53643628
Received: April 23, 2013
Revised: May 2, 2013
Accepted: May 9, 2013
Published online: June 14, 2013
Processing time: 52 Days and 9.4 Hours
Abstract

Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.

Keywords: Intraoperative blood salvage autotransfusion; Liver transplantation; Hepatocellular carcinoma; Leukocyte depletion filters; Allogeneic blood transfusion

Core tip: The use of intraoperative blood salvage autotransfusion (IBSA) in hepatocellular carcinoma (HCC) patients undergoing liver transplantation is controversial as it may reinfuse salvaged blood contaminated by tumor cells. In this article, we reviewed the relevant literature and tried to address the critical questions about IBSA. The available data indicate that IBSA is safe in liver transplantation for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.