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. 2022 Oct 18:12:985281.
doi: 10.3389/fonc.2022.985281. eCollection 2022.

Clinical prognosis of intraoperative blood salvage autotransfusion in liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis

Zheng Wang  1 , Saixin Li  1 , Yitong Jia  2 , Miao Liu  2 , Kun Yang  3 , Minghao Sui  1 , Dongbin Liu  1 , Kuo Liang  1
Affiliations

Clinical prognosis of intraoperative blood salvage autotransfusion in liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis

Zheng Wang et al. Front Oncol. .

Abstract

Background: Intraoperative blood salvage autotransfusion(IBSA) has been widely used in a variety of surgeries, but the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. Numerous studies have reported that IBSA used during LT for HCC is not associated with adverse oncologic outcomes. This systematic review and meta-analysis aims to estimate the clinical prognosis of IBSA for patients with H+CC undergoing LT.

Methods: MEDLINE, Embase, Web of Science, and Cochrane Library were searched for articles describing IBSA in HCC patients undergoing LT from the date of inception until May 1, 2022, and a meta-analysis was performed. Study heterogeneity was assessed by I2 test. Publication bias was evaluated by funnel plots, Egger's and Begg's test.

Results: 12 studies enrolling a total of 2253 cases (1374 IBSA and 879 non-IBSA cases) are included in this meta-analysis. The recurrence rate(RR) at 5-year(OR=0.75; 95%CI, 0.59-0.95; P=0.02) and 7-year(OR=0.65; 95%CI, 0.55-0.97; P=0.03) in the IBSA group is slightly lower than non-IBSA group. There are no significant differences in the 1-year RR(OR=0.77; 95% CI, 0.56-1.06; P=0.10), 3-years RR (OR=0.79; 95% CI, 0.62-1.01; P=0.06),1-year overall survival outcome(OS) (OR=0.90; 95% CI, 0.63-1.28; P=0.57), 3-year OS(OR=1.16; 95% CI, 0.83-1.62; P=0.38), 5-year OS(OR=1.04; 95% CI, 0.76-1.40; P=0.82),1-year disease-free survival rate(DFS) (OR=0.80; 95%CI, 0.49-1.30; P=0.36), 3-year DFS(OR=0.99; 95%CI, 0.64-1.55; P=0.98), and 5-year DFS(OR=0.88; 95%CI, 0.60-1.28; P=0.50). Subgroup analysis shows a difference in the use of leukocyte depletion filters group of 5-year RR(OR=0.73; 95%CI, 0.55-0.96; P=0.03). No significant differences are found in other subgroups.

Conclusions: IBSA provides comparable survival outcomes relative to allogeneic blood transfusion and does not increase the tumor recurrence for HCC patients after LT.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022295479.

Keywords: hepatocellular carcinoma; intraoperative blood salvage autotransfusion; leukocyte depletion filters; liver transplantation; meta-analysis.; treatment outcome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the selection and screening process for eligible studies.
Figure 2
Figure 2
Meta-analysis forest plot of the recurrence rate. (A), 1-year RR; (B), 3-year RR; (C), 5-year RR; (D), 7-year RR.
Figure 3
Figure 3
Meta-analysis forest plot of the overall survival. (A), 1-year OS; (B), 3-year OS; (C), 5-year OS.
Figure 4
Figure 4
Meta-analysis forest plot of the disease-free survival. (A), 1-year DFS; (B), 3-year DFS; (C), 5-year DFS.
Figure 5
Figure 5
Meta-analysis forest plot of subgroup analysis of the recurrence rate. (A), 1-year RR; (B), 3-year RR; (C), 5-year RR; (D), 7-year RR.
Figure 6
Figure 6
Meta-analysis forest plot of subgroup analysis of the overall survival. (A), 1-year OS; (B), 3-year OS; (C), 5-year OS.
See this image and copyright information in PMC

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