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

Abstract

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.

Impact of autotransfusion on recurrence of colorectal cancer liver metastasis: Long‐term follow‐up of patients undergoing curative intent hepatectomy

“…Furthermore, studies regarding its safety in hepatectomy for hepatocellular carcinoma, both retrospective and meta-analyses, have also been well-reported, such as recent works by Kwon and colleagues. [19][20][21][22][23][24] However, the comparative evidence specific to CRC is sparser. As discussed, several older studies have demonstrated viable circulating tumor cells (cTCs) in the peripheral blood of patients undergoing resection of CRLM.…”

“…Large pan‐cancer meta‐analyses have generally reported on the safety of autotransfusion. Furthermore, studies regarding its safety in hepatectomy for hepatocellular carcinoma, both retrospective and meta‐analyses, have also been well‐reported, such as recent works by Kwon and colleagues 19–24 . However, the comparative evidence specific to CRC is sparser.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…Wang et al performed a systematic review and meta-analysis of the literature published until May 1, 2022. 75 They identified 12 studies enrolling 2253 cases undergoing LT for HCC (1374 IAT and 879 non-IAT cases). The recurrence rate of HCC in the IAT group was slightly lower than that in the non-IAT group at 5 years (OR .75; 95% CI, .59-.95; P = .02) and 7 years (OR .65; 95% CI, .55-.97; P = .03).…”