Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma

Abstract

Aim: To evaluate the significance of autologous blood transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for hepatocellular carcinoma (HCC).

Methods: The proportion of patients who received HT was compared between two groups determined by the time of AT introduction; period A (1991-1994, n = 93) and period B (1995-2000, n = 201). Multivariate logistic regression analysis was performed in order to identify independent significant predictors of the need for HT. We also investigated the impact of AT and HT on long-term postoperative outcome after curative surgery for HCC.

Results: The proportion of patients with HT was significantly lower in period B than period A (18.9% vs 60.2%, P < 0.0001). Multivariate logistic regression analysis identified AT administration as a significant independent predictor of the need for HT (P < 0.0001). Disease-free survival in patients with AT was comparable to that without any transfusion. Multivariate analysis identified HT administration as an independent significant factor for poorer disease-free survival (P = 0.0380).

Conclusion: AT administration significantly decreased the need for HT. Considering the postoperative survival disadvantage of HT, AT administration could improve the long-term outcome of HCC patients.

Keywords: Auto-logous blood transfusion; Hepatocellular carcinoma; Homologous blood transfusion; Surgery.

Figure 1

Distribution of patients according to transfusion status during periods A and B. The proportion of patients who received HT was significantly lower in period B than period A (^aP < 0.0001). AT: Autologous transfusion; HT: Homologous transfusion.

Figure 2

Disease-free survival after curative surgery for hepatocellular carcinoma. A: There were no significant differences between the non-transfusion group (solid line) and the Autologous transfusion (AT) group (dotted line) (P = 0.3874); B: The cumulative disease-free survival in the non-Homologous transfusion (HT) group (solid line) was significantly better than in the HT group (dotted line) (^aP = 0.0305); C: The disease-free survival in the non-HT group (solid line) was significantly better in than the HT group (dotted line) in patients with maximum tumor size of ≤ 5.0 cm (^aP = 0.0452); D: No significant differences were noted between the non-HT group (solid line) and the HT group (dotted line) in patients with the maximum tumor size > 5.0 cm (P = 0.7391).