Intraoperative cell salvage with autologous transfusion in liver transplantation

Abstract

Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

“…Age at the time of LT was 51 [44.5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease [7], was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5%) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4%), primary biliary cirrhosis (n = 1, 7.7%), alpha-1 antitrypsin deficiency (n = 1, 7.7%) and hemochromatosis (n = 1, 7.7%), (…”

“…The use of ICS in patients with hepatocellular carcinoma could be discussed because of the potential risk of infusing malignant cells into patients. To date, 4 studies have evaluated the oncological safety of using ICS in LT. One concluded that the device is effective in removing malignant cells from the aspirate, except in cases of tumor rupture whereas the other 3, evaluating clinical outcomes such as mortality and recurrence, did not demonstrate negative effects associated with the use of ICS [19]. On the contrary, the use of cell salvage during LT for hepatocellular carcinoma has been found to reduce the exposure to allogeneic blood and to be costeffective [20].…”

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

“…5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease 8 , was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5 %) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4 %), primary biliary cirrhosis (n = 1, 7.7 %), alpha-1 antitrypsin deficiency (n = 1, 7.7 %) and hemochromatosis (n = 1, 7.7 %), ( Table 2 whereas Table 3 Finally, of the 13 JW recipients, 12 (92.3 %) were alive at the 1 year follow-up interview: 1 patient died 11 months from LT due to ischemic-type biliary lesions (ITBL)-related septic complications.…”

“…The use of ICS in patients with hepatocellular carcinoma could be discussed because of the potential risk of infusing malignant cells into patients. To date, 4 studies have evaluated the oncological safety of using ICS in LT. One concluded that the device is effective in removing malignant cells from the aspirate, except in cases of tumor rupture whereas the other 3, evaluating clinical outcomes such as mortality and recurrence, did not demonstrate negative effects associated with the use of ICS 20 . On the contrary, the use of cell salvage during LT for hepatocellular carcinoma has been found to reduce the exposure to allogeneic blood and to be cost-effective 21 .…”

CTCs Detection from Intraoperative Salvaged Blood in RCC-IVC Thrombus Patients by Negative Enrichment and iFISH Identification - A Preliminary Study

“…Immune reactions may occur during allogeneic blood transfusion, leading to acute cell rejection. Allogeneic transfusion is an independent risk factor for cancer-speci c mortality and overall mortality in patients with malignancies [6]. It is concerned that allogeneic transfusion may result in immunosuppression and possible adverse effects on urological cancer recurrence [7,8].…”