Background

Intraoperative autologous transfusion (IAT) of salvaged blood is a common method of resuscitation during liver transplantation (LT), however concern for recurrence in recipients with hepatocellular carcinoma (HCC) has limited widespread adoption.

Methods

A review of patients undergoing LT for HCC between 2008 and 2018 was performed. Clinicopathologic and intraoperative characteristics associated with inferior recurrence-free (RFS) and overall survival (OS) were identified using Kaplan–Meier analysis and uni-/multi-variable Cox proportional hazards modeling. Propensity matching was utilized to derive clinicopathologically similar groups for subgroup analysis.

Results

One-hundred-eighty-six patients were identified with a median follow up of 65 months. Transplant recipients receiving IAT (n = 131, 70%) also had higher allogenic transfusions (median 5 versus 0 units, P < 0.001). There were 14 recurrences and 46 deaths, yielding an estimated 10-year RFS and OS of 89% and 67%, respectively. IAT was not associated with RFS (HR 0.89/liter, P = 0.60), or OS (HR 0.98/liter, P = 0.83) pre-matching, or with RFS (HR 0.97/liter, P = 0.92) or OS (HR 1.04/liter, P = 0.77) in the matched cohort (n = 49 per group).

Conclusion

IAT during LT for HCC is not associated with adverse oncologic outcomes. Use of IAT should be encouraged to minimize the volume of allogenic transfusion in patients undergoing LT for HCC.

中文翻译：

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肝细胞癌肝移植术中自体输血和肿瘤学结局：倾向匹配分析

背景

挽救血液的术中自体输血 (IAT) 是肝移植 (LT) 期间复苏的常用方法，但对肝细胞癌 (HCC) 受体复发的担忧限制了其广泛采用。

方法

对 2008 年至 2018 年间因 HCC 接受 LT 的患者进行了回顾。使用 Kaplan-Meier 分析和单/多变量 Cox 比例风险模型确定与劣质无复发 (RFS) 和总生存期 (OS) 相关的临床病理学和术中特征。倾向匹配用于得出临床病理学相似的组以进行亚组分析。

结果

确定了 186 名患者，中位随访时间为 65 个月。接受 IAT 的移植受者（n = 131, 70%）也有较高的同种异体输血（中位数 5 对 0 单位，P  < 0.001）。有 14 例复发和 46 例死亡，估计 10 年 RFS 和 OS 分别为 89% 和 67%。IAT 与 RFS（HR 0.89/L，P  = 0.60）或 OS（HR 0.98/L，P  = 0.83）预匹配，或与 RFS（HR 0.97/L，P  = 0.92）或 OS（HR 1.04/L，P  = 0.77）在匹配的队列中（每组 n = 49）。

结论

HCC LT 期间的 IAT 与不良肿瘤学结果无关。应鼓励使用 IAT 以尽量减少因 HCC 接受 LT 的患者的同种异体输血量。