Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score–matched case–control analysis

Zacharias, Thomas; Ahlschwede, Erich; Dufour, Nicole F.; Romain, Florence; Theissen-Laval, Odile

doi:10.1503/cjs.010017

Cited by 11 publications

(30 citation statements)

References 45 publications

(101 reference statements)

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“…One study (125 patients) demonstrated significantly shorter length of stay in the IBSA group (5.8±1.6 d IBSA vs 7.7±2.1 d control, P <0.05) and lower average costs (55,400±15,400 CAD IBSA vs 66,700±21,600 CAD control, P <0.05) 55. Three other studies (303 patients) showed no difference in length of stay 41,48,54…”

Section: Resultsmentioning

confidence: 98%

“… 39 , 45 Sixteen studies included patients who underwent liver transplantation (2667 patients, 77.7%), 16 , 17 , 38 , 41 – 47 , 49 – 54 whereas 5 studies included patients undergoing hepatic resection (766 patients, 22.3%). 39 , 48 , 55 – 57 …”

Section: Resultsmentioning

confidence: 99%

“…56,57 One study (230 patients) showed significantly fewer infectious complications in the IBSA group (57.9% vs 74.3%, 55 Three other studies (303 patients) showed no difference in length of stay. 41,48,54 Other Secondary Outcomes…”

Section: Core Secondary Outcomesmentioning

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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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: 98%

Section: Resultsmentioning

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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“…In this investigation, we found that a suction pressure of less than 0.03 MPa should be used for orthopedic surgery, cardiovascular surgery, organ transplant surgery, brain surgery, and emergency surgery, which can help guide the clinical application of intraoperative salvage autotransfusion. Minimum initial blood volume is required by the CATS plus system to process; in this research, less than four units transfusion was determined for minimal renal function damage ( 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of transfusion load and suction pressure on renal function in intraoperative salvage autotransfusion

Zeng

Zhang

et al. 2021

Braz J Med Biol Res

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“…The intraoperative transfusion management included measures to avoid and at the same time, prepare, for incompatible transfusion; autologous blood collection as ANH immediately prior to operation [14]; setting for blood salvage with a cell saver [15]; insertion of a flexible double lumen catheter for CHDF [16]. ANH is known to be one of the best strategies to prevent perioperative red blood cells (RBCs) transfusion; however, the amount of blood withdrawal, leading hemodilutional coagulopathy and fluid overload remain major concern [14].…”

Section: Discussionmentioning

confidence: 99%

Central hepatectomy for hepatocellular carcinoma in a patient with anti-Gerbich antibody

et al. 2020

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Background: Anti-Gerbich (Ge) alloantibody against high-frequency erythrocyte antigen is extremely rare. Owing to incomplete evidence regarding the degree and severity of adverse events induced by hemolytic transfusion reactions, the transfusion management often remains cumbersome in these patients. We report an anti-Ge alloantibody positive patient with hepatocellular carcinoma (HCC) who underwent central hepatectomy (CH) without the need for an allogeneic blood transfusion. Case presentation: A 76-year-old Japanese woman was diagnosed with HCC measuring 9.5 × 8.0 cm in segments 4, 5, and 8 of the liver. This patient with anti-Ge alloantibody had a history of two pregnancies without transfusion. CH was planned, and based on the suggestion from the multidisciplinary team meeting, preoperative autologous donation (PAD) and acute normovolemic hemodilution (ANH) were performed. CH was successfully performed by using CUSA and Thunderbeat® with Pringle maneuver and infra-hepatic inferior vena cava clamping without perioperative need for an allogeneic blood transfusion. She has been alive without recurrence after a follow-up period of 45 months. Conclusion: To our knowledge, this is the first case report of hepatectomy in a patient with anti-Ge alloantibody. A multidisciplinary team approach, PAD and ANH, and bloodless liver surgical techniques appear to be useful for major hepatectomy in patients with extremely rare blood type.

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Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score–matched case–control analysis

Cited by 11 publications

References 45 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

Effects of transfusion load and suction pressure on renal function in intraoperative salvage autotransfusion

Central hepatectomy for hepatocellular carcinoma in a patient with anti-Gerbich antibody

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