Is the use of intra-operative blood salvage autotransfusion in hepatocellular carcinoma liver transplantation safe? A comparative analysis of long-term outcomes

Abstract

Conclusion: Large HCC by itself is not a contraindication for surgery and curative resection remains the treatment of choice in patients with good performance status and preserved liver function. TACE followed by PVE is the preferred method for FLR augmentation to facilitate curative resection in these cases. Sorafenib is the drug of choice in case of disease progression or metastasis after curative resection. Upfront resectable local recurrence should be operated to negative margins in appropriately selected cases. Regorafenib or cabozantinib are second line agents for HCC after sorafenib resistance or intolerance.

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

“…Three studies reported a statistically significant difference in intraoperative blood loss between the IBSA and control groups 44,51,52. One study reported significantly greater blood loss in the control group 51.…”

“… 44 , 51 , 52 One study reported significantly greater blood loss in the control group. 51 Two studies reported greater intraoperative blood loss in the IBSA group, 44 , 52 with 1 reporting a significantly longer operative time in the IBSA group. 52 …”

“…Risk of bias assessment for the included studies is presented in Figure 2 . Overall, 5 studies were considered at high risk of bias (MINORS score <17), 44 , 46 , 51 , 53 , 55 with the remainder being at low risk of bias. Of the 21 studies, 1 had a reported but inadequately stated aim, 53 and 1 had an inadequate control group (use of Pringle manoeuvre).…”

“…All studies had appropriate endpoints; however, 2 studies did not have appropriate follow-up for their measured outcome of interest 41,55. Fourteen studies either did not report or had ˃5% loss to follow-up 16,17,38,39,43,44,46,47,49,51,54–57. Six studies had some degree of prospective data collection,16,39,42,43,45,49 with the remainder having only retrospective data collection.…”

“…17,38,41,[49][50][51][52]54 Thirteen studies included patients who underwent transplantation for a known oncologic indication, or were found to have incidental malignancy on explant pathology (1774/2667 patients, 66.5%). 16,17,38,41,[43][44][45]47,[49][50][51][52]54 Of these studies, 924 patients were in the IBSA group, 638 patients in control group, and the grouping was not specified for the remaining 212 patients. Twelve of these studies included patients with HCC.…”