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Meta-Analysis
. 2022 Aug 1;276(2):239-245.
doi: 10.1097/SLA.0000000000005476. Epub 2022 Jul 6.

Safety of Intraoperative Blood Salvage During Liver Transplantation in Patients With Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Virginia J Aijtink  1 , Vera C Rutten  1 , Beatrice E M Meijer  1 , Renate de Jong  2 , John L Isaac  3 , Wojciech G Polak  1 , M Thamara P R Perera  4   5 , Dimitri Sneiders  1   4 , Hermien Hartog  4   5
Affiliations
Meta-Analysis

Safety of Intraoperative Blood Salvage During Liver Transplantation in Patients With Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Virginia J Aijtink et al. Ann Surg. .

Abstract

Objective: The effects of intraoperative blood salvage (IBS) on time to tumor recurrence, disease-free survival and overall survival in hepatocellular carcinoma (HCC) patients undergoing liver transplantation were assessed to evaluate the safety of IBS.

Background: IBS is highly effective to reduce the use of allogeneic blood transfusion. However, the safety of IBS during liver transplantation for patients with HCC is questioned due to fear of disseminating malignant cells.

Methods: Comprehensive searches through June 2021 were performed in 8 databases. The methodological quality of included studies was assessed using the Robins-I tool. Meta-analysis with the generic inverse variance method was performed to calculate pooled hazard ratios (HRs) for disease-free survival, HCC recurrence and overall survival.

Results: Nine studies were included (n=1997, IBS n=1200, no-IBS n=797). Use of IBS during liver transplantation was not associated with impaired disease-free survival [HR=0.90, 95% confidence interval (CI)=0.66-1.24, P=0.53, IBS n=394, no-IBS n=329], not associated with increased HCC recurrence (HR=0.83, 95% CI=0.57-1.23, P=0.36, IBS n=537, no-IBS n=382) and not associated with impaired overall survival (HR=1.04, 95% CI=0.79-1.37, P=0.76, IBS n=495, no-IBS n=356).

Conclusions: Based on available observational data, use of IBS during liver transplantation in patients with HCC does not result in impaired disease-free survival, increased HCC recurrence or impaired overall survival. Therefore, use of IBS during liver transplantation for HCC patients is a safe procedure.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram.
FIGURE 2
FIGURE 2
Forest plots representing disease-free survival. A, Forest plot includes uncorrected estimates only. B, Forest plot includes corrected estimates (propensity score matching or multivariable cox regression) if available.
FIGURE 3
FIGURE 3
Forest plots representing risk for HCC recurrence. A, Forest plot includes uncorrected estimates only. B, Forest plot includes corrected estimates (propensity score matching or multivariable cox regression) only. C, Forest plot includes uncorrected estimates and corrected estimates (propensity score matching or multivariable cox regression) if available.
See this image and copyright information in PMC

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