Should Cell Salvage Be Used in Liver Resection and Transplantation? A Systematic Review and Meta-analysis

Abstract

Objective: To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery. Background: Intraoperative RBC transfusions are common in liver surgery and associated with increased morbidity. IBSA can be utilized to minimize allogeneic transfusion. A theoretical risk of cancer dissemination has limited IBSA adoption in oncologic surgery. Methods: Electronic databases were searched from inception until May 2021. All studies comparing IBSA use with control in liver surgery were included. Screening, data extraction, and risk of bias assessment were conducted independently, in duplicate. The primary outcome was intraoperative allogeneic RBC transfusion (proportion of patients and volume of blood transfused). Core secondary outcomes included: overall survival and disease-free survival, transfusion-related complications, length of hospital stay, and hospitalization costs. Data from transplant and resection studies were analyzed separately. Random effects models were used for meta-analysis. Results: Twenty-one observational studies were included (16 transplant, 5 resection, n=3433 patients). Seventeen studies incorporated oncologic indications. In transplant, IBSA was associated with decreased allogeneic RBC transfusion [mean difference –1.81, 95% confidence interval (−3.22, −0.40), P=0.01, I2=86%, very-low certainty]. Few resection studies reported on transfusion for meta-analysis. No significant difference existed in overall survival or disease-free survival in liver transplant [hazard ratio (HR)=1.12 (0.75, 1.68), P=0.59, I2=0%; HR=0.93 (0.57, 1.48), P=0.75, I2=0%] and liver resection [HR=0.69 (0.45, 1.05), P=0.08, I2=0%; HR=0.93 (0.59, 1.45), P=0.74, I2=0%]. Conclusion: IBSA may reduce intraoperative allogeneic RBC transfusion without compromising oncologic outcomes. The current evidence base is limited in size and quality, and high-quality randomized controlled trials are needed.

Efficacy of intraoperative blood salvage and autotransfusion in living-donor liver transplantation: a retrospective cohort study

“…The use of IBSA in LT has been analyzed in several observational studies. Similar to the results of our study, a reduction in intraoperative allogeneic transfusion owing to IBSA use was reported by several studies [22][23][24].…”

ScRNA‐seq revealed disruption in CD8+ NKG2A+ natural killer T cells in patients after liver transplantation and immunosuppressive therapy

“…Currently, LT is a highly effective treatment for these indications 17 . In patients who undergo LT with long‐term immunosuppressive therapy, peripheral blood cells are diverse, neutralize immune rejection/tolerance‐associated cells, and are essential for the regulation of immune tolerance after LT 18 . In this study, we used scRNA‐seq to examine the heterogeneity and dynamic changes in peripheral blood cells in individual N and patients M2, Y1, Y3, and Y7 at the single cell level.…”

What's new in whole blood resuscitation? In the trauma bay and beyond

“…Patients undergoing complex aortic surgery with hypothermic circulatory arrest, demonstrated reduced allogenic transfusion requirements when receiving intra-operative prepump autologous whole blood autotransfusion [68]. A recent meta-analysis showed no difference in overall and disease-free survival after liver resection or transplantation with cell salvage [69].…”