Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2016; 8(2): 161-168
Published online Feb 27, 2016. doi: 10.4240/wjgs.v8.i2.161
Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence?
Raphael LC Araujo, Carlos Andrés Pantanali, Luciana Haddad, Joel Avancini Rocha Filho, Luiz Augusto Carneiro D’Albuquerque, Wellington Andraus
Raphael LC Araujo, Liver Surgery Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, CEP 05403-900, Brazil
Carlos Andrés Pantanali, Luciana Haddad, Joel Avancini Rocha Filho, Luiz Augusto Carneiro D’Albuquerque, Division of Liver and Gastrointestinal Transplant, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, CEP 05403-900, Brazil
Joel Avancini Rocha Filho, Wellington Andraus, Department of Anesthesiology, University of São Paulo School of Medicine, São Paulo, CEP 05403-900, Brazil
Author contributions: Araujo RLC and Andraus W contributed equally to design this work; Araujo RLC, Pantanali CA, Haddad L and Andraus W collected the data; Araujo RLC, Rocha Filho JA, D’Albuquerque LAC and Andraus W analyzed the data; all authors equally reviewed the paper.
Institutional review board statement: This study was approved by the Ethics Committee in Research of University of São Paulo School of Medicine.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: None of the authors has received fees for serving as a speaker, consultant or advisory board member for any organization that might have a stake in the results of this study; nor do any of the authors owns stocks or shares of any such organization. None of the authors owns any patents related to the materials, devices or procedures mentioned in the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding authors at wellington@usp.br and raphael-araujo@usp.br.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wellington Andraus, MD, PhD, Department of Anesthesiology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255, 9º Andar, Sala 9113/9114, São Paulo, CEP 05403-900, Brazil. wellington@usp.br
Telephone: +55-11-26613323 Fax: +55-11-26619008
Received: July 3, 2015
Peer-review started: July 10, 2015
First decision: September 17, 2015
Revised: November 7, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: February 27, 2016
Abstract

AIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS).

METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed according to the use of IBS or not. Demographic and surgical data were collected from a departmental prospective maintained database. Statistical analyses were performed using the Fisher’s exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kaplan-Meier method and compared by the log-rank test.

RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the non-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and non-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes).

CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes.

Keywords: Cell saver, Cancer, Hepatocellular carcinoma, Liver transplantation, Recurrence

Core tip: This study addresses an alternative option for allogeneic blood transfusion during liver transplantation (LT) for hepatocellular carcinoma (HCC). The autologous blood salvage in LT, in our series, did not impact recurrence or death. This suggests that autologous blood transfusion should be considered an option avoiding the deleterious effects of allogeneic blood transfusion. Overall, we do believe that our data claim for trials looking for non-inferiority comparing the two modalities of blood transfusion in patients who underwent LT for HCC. We do believe that further studies are justified and should be designed to detect small differences in long-term outcomes.