Cell Salvage During Liver Transplantation for Hepatocellular Carcinoma: A Retrospective Analysis of Tumor Recurrence Following Irradiation of the Salvaged Blood

Weller, Astrid; Seyfried, Timo; Ahrens, Norbert; Baier-Kleinhenz, Lucia; Schlitt, Hans-Jürgen; Peschel, G; Graf, Bernhard M.; Sinner, Barbara

doi:10.1016/j.transproceed.2021.03.025

Cited by 11 publications

(35 citation statements)

References 42 publications

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“… 16 One study included 5/39 (12.8%) patients in the IBSA group that were presumed to be tumor-free or who had treated HCC. 47 Four studies had center or contemporary time period differences between intervention groups. 39 , 48 , 51 , 52 In addition, 5 studies utilized LDF before autotransfusion.…”

Section: Resultsmentioning

confidence: 99%

“…The other sixteen studies either did not incorporate LDF or did not report its use. Similarly, irradiation of autologous blood is another potential adjunctive methodology that can remove viable tumor cells 47. It also can lead to delayed reinfusion of the autologous blood, which can consequently influence allogeneic transfusion requirements and survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…com/SLA/E83). 17,38,42,46,47,53 One study (150 patients) demonstrated significantly higher postoperative hemoglobin in the IBSA group (93.8 ± 19.3 g/L IBSA vs 85.2 ± 17.8 g/L control, P < 0.0001), 52 whereas 2 other studies (176 patients) showed no significant difference. 47,55…”

Section: Core Secondary Outcomesmentioning

confidence: 96%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…The remaining articles were fully read. Finally, 12 studies enrolling a total of 2253 cases (1374 IBSA cases and 879 non-IBSA cases) were included in the meta-analysis ( 14 , 27 – 37 ). The process used for article selection is presented in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies reported the recurrence rate(RR) outcomes of IBSA and non-IBSA patients. Of them, seven studies provided a specified description of criteria for determining the recurrence and follow-up methods ( 14 , 27 , 29 , 32 , 35 – 37 ). The meta-analysis data is displayed in Figure 2 , the RR at 5-year(OR=0.75; 95%CI, 0.59-0.95; P=0.02) and 7-year(OR=0.65; 95%CI, 0.44-0.95; P=0.03) in the IBSA group was slightly lower than non-IBSA group.…”

Section: Resultsmentioning

confidence: 99%

Clinical prognosis of intraoperative blood salvage autotransfusion in liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis

Wang

Jia

et al. 2022

Front. Oncol.

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BackgroundIntraoperative blood salvage autotransfusion(IBSA) has been widely used in a variety of surgeries, but the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. Numerous studies have reported that IBSA used during LT for HCC is not associated with adverse oncologic outcomes. This systematic review and meta-analysis aims to estimate the clinical prognosis of IBSA for patients with H+CC undergoing LT.MethodsMEDLINE, Embase, Web of Science, and Cochrane Library were searched for articles describing IBSA in HCC patients undergoing LT from the date of inception until May 1, 2022, and a meta-analysis was performed. Study heterogeneity was assessed by I2 test. Publication bias was evaluated by funnel plots, Egger’s and Begg’s test.Results12 studies enrolling a total of 2253 cases (1374 IBSA and 879 non-IBSA cases) are included in this meta-analysis. The recurrence rate(RR) at 5-year(OR=0.75; 95%CI, 0.59-0.95; P=0.02) and 7-year(OR=0.65; 95%CI, 0.55-0.97; P=0.03) in the IBSA group is slightly lower than non-IBSA group. There are no significant differences in the 1-year RR(OR=0.77; 95% CI, 0.56-1.06; P=0.10), 3-years RR (OR=0.79; 95% CI, 0.62-1.01; P=0.06),1-year overall survival outcome(OS) (OR=0.90; 95% CI, 0.63-1.28; P=0.57), 3-year OS(OR=1.16; 95% CI, 0.83-1.62; P=0.38), 5-year OS(OR=1.04; 95% CI, 0.76-1.40; P=0.82),1-year disease-free survival rate(DFS) (OR=0.80; 95%CI, 0.49-1.30; P=0.36), 3-year DFS(OR=0.99; 95%CI, 0.64-1.55; P=0.98), and 5-year DFS(OR=0.88; 95%CI, 0.60-1.28; P=0.50). Subgroup analysis shows a difference in the use of leukocyte depletion filters group of 5-year RR(OR=0.73; 95%CI, 0.55-0.96; P=0.03). No significant differences are found in other subgroups.ConclusionsIBSA provides comparable survival outcomes relative to allogeneic blood transfusion and does not increase the tumor recurrence for HCC patients after LT.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022295479.

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2023 Clinical Update in Liver Transplantation

Laporte,

Brown,

Wilke

et al. 2024

Journal of Cardiothoracic and Vascular Anesthesia

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Cell Salvage During Liver Transplantation for Hepatocellular Carcinoma: A Retrospective Analysis of Tumor Recurrence Following Irradiation of the Salvaged Blood

Cited by 11 publications

References 42 publications

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

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

Clinical prognosis of intraoperative blood salvage autotransfusion in liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis

2023 Clinical Update in Liver Transplantation

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