Liver Transplantation for Hepatocellular Carcinoma – Is There a Risk of Recurrence Caused by Intraoperative Blood Salvage Autotransfusion?

Abstract

Background/Aims: The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC). Methods: In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group). Results: Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group. Conclusion: Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.

Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery?

“…The sequence of these studies confirmed the three steps which forms ''a logical sequence for proofof-concept.'' There were two other recent studies by hepatobiliary oncologists where they reinfused salvaged blood in 40 patients [27] and 121 patients [17] undergoing liver Eur Spine J transplantation for hepatocellular carcinoma. They also concluded that salvaged blood was safe for reinfusion.…”

A review of the application of autologous blood transfusion

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Stem-like plasticity and heterogeneity of circulating tumor cells: current status and prospect challenges in liver cancer

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