Background

The impact of packed Red Blood Cell (pRBC) transfusion on oncological outcomes after liver transplantation (LT) for Hepatocellular Carcinoma (HCC) remains controversial. We evaluated the impact of pRBC transfusion on HCC recurrence and overall survival (OS) after LT for HCC.

Methods

Patients with HCC transplanted between 2000 and 2018 were included and stratified by receipt of pRBC transfusion. Outcomes were HCC recurrence and OS. Propensity score matching was performed to account for confounders.

Results

Of the 795 patients, 234 (29.4%) did not receive pRBC transfusion. After matching the 1-, 3-, and 5-year cumulative incidence of recurrence was 6.6%, 12.5% and 14.8% for no-pRBC transfusion, and 8.6%, 18.8% and 21.3% (p = 0.61) for pRBC transfusion. The OS at 1-, 3-, 5-year was 93.0%, 84.6% and 75.8% vs 92.0%, 79.7% and 73.5% (p = 0.83) for no-pRBC transfusion and pRBC transfusion, respectively. There were no differences in recurrence (HR 1.13, 95%CI 0.71–1.78, p = 0.61) or OS (HR 1.04, 95%CI 0.71–1.54, p = 0.83).

Conclusion

Perioperative administration of pRBC in liver transplant recipients for HCC resulted in a nonsignificant increase of HCC recurrence and death after accounting for confounder. Surgeons should continue to exercise cation and optimize patients iron stores medically preoperatively.

中文翻译：

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围手术期输注浓缩红细胞对肝癌肝移植术后患者预后的影响

背景

浓缩红细胞 (pRBC) 输注对肝细胞癌 (HCC) 肝移植 (LT) 后肿瘤学结果的影响仍存在争议。我们评估了 pRBC 输注对 HCC LT 后 HCC 复发和总生存期 (OS) 的影响。

方法

纳入 2000 年至 2018 年间移植的 HCC 患者，并根据接受 pRBC 输血进行分层。结果是HCC复发和OS。进行倾向得分匹配以解决混杂因素。

结果

在 795 名患者中，234 名 (29.4%) 未接受 pRBC 输血。在匹配 1 年、3 年和 5 年累积复发率后，无 pRBC 输血的累积复发率为 6.6%、12.5% 和 14.8%，而 pRBC 输血的复发率为 8.6%、18.8% 和 21.3% (p = 0.61)。1、3、5 年的 OS 分别为 93.0%、84.6% 和 75.8%，而无 pRBC 输血和 pRBC 输血的 OS 分别为 92.0%、79.7% 和 73.5% (p = 0.83)。复发 (HR 1.13, 95%CI 0.71–1.78, p = 0.61) 或 OS (HR 1.04, 95%CI 0.71–1.54, p = 0.83) 没有差异。

结论

在考虑混杂因素后，在肝移植受者的 HCC 围手术期使用 pRBC 导致 HCC 复发和死亡的增加不显着。外科医生应在术前继续锻炼阳离子并优化患者的铁储备。