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. 2019 Nov;43(11):2894-2901.
doi: 10.1007/s00268-019-05085-w.

Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Yo-Ichi Yamashita  1 , Hiromitsu Hayashi  2 , Katsunori Imai  2 , Hirohisa Okabe  2 , Shigeki Nakagawa  2 , Fumimasa Kitamura  2 , Norio Uemura  2 , Yosuke Nakao  2 , Toshihiko Yusa  2 , Rumi Itoyama  2 , Takanobu Yamao  2 , Naoki Umesaki  2 , Tatsunori Miyata  2 , Akira Chikamoto  2 , Mototsugu Shimokawa  3 , Hideo Baba  2
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Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Yo-Ichi Yamashita et al. World J Surg. 2019 Nov.

Abstract

Background: Whether perioperative allogeneic blood transfusion (PABT) negatively influences patient survival after hepatectomy (HR) for hepatocellular carcinoma (HCC) remains controversial.

Methods: Five hundred two patients who underwent HR for initial HCC between 1994 and 2015 were enrolled in this study. All patients were divided into two groups: the PABT group and the non-PABT group. Differences of clinicopathological factors, overall survival (OS), recurrence-free survival (RFS), and the recurrence pattern between the two groups were evaluated. Using propensity score matching for tumor-related factors, liver functions, and surgical factors (total 11 factors), the survival impact of PABT was also analyzed.

Results: In the entire cohort, 78 patients (15.5%) received PABT such as red cell concentrate, fresh-frozen plasma, or platelets. OS (5-year OS: 55% vs. 76%; p = 0.0005) and RFS (2-year RFS: 47% vs. 56%; p = 0.0131) were significantly worse in the PABT group. The extrahepatic recurrence happened more frequently in the PABT group (15% vs. 5.4%; p = 0.0039). There were many significant clinicopathological differences between the two groups: more advanced tumor stage (tumor diameter, stage III or IV, microvascular invasion), worse liver functions (albumin, indocyanine green retention rate at 15 min), and more surgical stress (blood loss, operation time) in the PABT group. After propensity score matching, 43 pairs of patients were extracted. In this matched cohort, the survival curves of the PABT and non-PABT groups almost completely overlapped both in OS (5-year OS: 62% vs. 62%; p = 0.4384) and in RFS (2-year RFS: 49% vs. 47%; p = 0.8195). The significant difference of the extrahepatic recurrence rate disappeared in the matched cohort (p = 0.5789).

Conclusion: Using propensity score matching, we found that PABT does not influence patient survival after HR for HCC.

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