Objective: To compare the oncologic outcomes of liver resection (LR) and local ablation therapies for HCC. Summary of Background Data: Although several studies have compared LR and local ablation therapies, the optimal treatment of choice for HCC within the Milan criteria remains controversial. Methods: We systemically searched the MEDLINE, Embase, and Cochrane Library databases for randomized control trials (RCTs) and matched nonrandomized trials (NRTs) that compared LR and local ablation therapies for HCC within the Milan criteria. The primary outcome was overall survival (OS). Secondary outcomes were recurrence free survival (RFS) and recurrence pattern. Results: A total of 7 RCTs and 18 matched NRTs, involving 2865 patients in the LR group and 2764 patients in the local ablation therapy group [RFA, MWA, RFA plus trans-arterial chemoembolization (TACE)], were included. Although there was no significant difference in OS between LR and RFA, LR showed a significantly better 5-year RFS than RFA in the analysis of RCTs (hazards ratio: 0.75; 95% confidence interval: 0.62–0.92; P = 0.006). The RFA group showed a significantly higher local recurrence than the LR group in both analyses of RCTs and NRTs. Additionally, the LR group showed better OS and RFS than the MWA or RFA plus TACE groups. Conclusion: Our meta-analysis showed that LR was superior to RFA in terms of RFS and incidence of local recurrence. Moreover, LR showed better oncologic outcomes than MWA or RFA plus TACE.

Background: Despite retrospective studies comparing anatomical liver resection (AR) and non-anatomical liver resection (NAR), the efficacy and benefits of AR for hepatocellular carcinoma remain unclear. Materials and methods: The authors systemically reviewed MEDLINE, Embase, and Cochrane Library for propensity score matched cohort studies that compared AR and NAR for hepatocellular carcinoma. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Secondary outcomes were recurrence patterns and perioperative outcomes. Results: Overall, 22 propensity score matched studies (AR, n=2,496; NAR, n=2590) were included. AR including systemic segmentectomy was superior to NAR regarding the 3-year and 5-year OS. AR showed significantly better 1-year, 3-year, and 5-year RFS than NAR, with low local and multiple intrahepatic recurrence rates. In the subgroup analyses of tumour diameter less than or equal to 5 cm and tumours with microscopic spread, the RFS in the AR group was significantly better than that in the NAR group. Patients with cirrhotic liver in the AR group showed comparable 3-year and 5-year RFS with the NAR group. Postoperative overall complications were comparable between AR and NAR. Conclusions: This meta-analysis demonstrated that AR showed better OS and RFS with a low local and multiple intra-hepatic recurrence rate than NAR, especially in patients with tumour diameter less than or equal to 5 cm and non-cirrhotic liver.

There has been a lack of well-constructed practical guideline on blood component transfusion in ABO-incompatible sold organ transplantation patients. According to the survey conducted in Korea, they performed a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea. For ABO-incompatible solid organ transplant cases, the recipients ABO group was the most common choice of ABO group for RBC transfusion (70.6%), followed by group O (29.4%). The reason for transfusion of the recipients ABO group rather than the routine use of group O is lack of blood supply as well as to prevent unnecessary infusion of anti-A or anti-B antibodies. In choosing to transfuse RBCs according to this experts opinion, passenger lymphocyte syndrome (PLS) should be considered. PLS is unique type of graft-versus-host disease (GVHD) caused by the transfer of B-lymphocytes present in the donor graft into the recipient circulation. This circulating graft B-lymphocytes induce antibody-induced hemolysis by producing antibodies. Therefore, the patients typically show low hemoglobin and haptoglobin level and elevated lactate dehydrogenase (LDH) and bilirubin level without evidence of bleeding and thrombocytopenia. Unlike thrombotic microangiopathy (TMA), blood smear analysis does not show schistocyte. The direct antiglobulin test (DAT) can detect donor-derived antibodies on the surface of recipient RBCs. Fortunately, in most cases of PLS, symptoms generally mild and self-limited in 4-6 weeks after transplantation. Treatment of PLS is supportive care and transfusion of O RBCs. Especially after COVID-19 pandemic, problem of lack of blood storage in blood bank is getting worse. In order to prevent wastage of the transfused blood by unnecessary hemolysis, appropriate screening protocol for PLS is important. If a decrease in hemoglobin is observed without definite bleeding within 4 weeks after transplantation, preemptive DAT should be performed to confirm PLS before transfusion.