Tan Jarrod K H, Menon Nishanth V, Tan Pei Shan, Pan Terry L T, Bonney Glenn K, Shridhar Iyer G, Madhavan Krishnakumar, Lim Chwee Teck, Kow Alfred W C
Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Department of Biomedical Engineering, National University of Singapore, Singapore.
HPB (Oxford). 2021 Nov;23(11):1700-1707. doi: 10.1016/j.hpb.2021.04.006. Epub 2021 Apr 27.
The application of intra-operative blood salvage autotransfusion(IBSA) in liver transplantation(LT) for hepatocellular carcinoma(HCC) remains controversial due to the theoretical risk of tumour cell(TC) reintroduction. Current studies evaluating for presence of TC are limited by suboptimal detection techniques. This study aims to analyze the presence of TC in HCC LT autologous blood using microfluidics technology.
A prospective study of HCC patients who underwent LT from February 2018-April 2019 was conducted. Blood samples were collected peri-operatively. TCs were isolated using microfluidics technology and stained with antibody cocktails for confirmation.
A total of 15 HCC LT patients were recruited. All recipients had tumour characteristics within the University of California, San Francisco(UCSF) criteria pre-operatively. TC was detected in all of the autologous blood samples collected from the surgical field. After IOCS wash, five patients had no detectable TC, while 10 patients had detectable TC; of these two remained positive for TC after Leukocyte Depletion Filter(LDF) filtration.
The risk of tumour cell reintroduction using IBSA in HCC LT patients can be reduced with a single LDF. Future studies should evaluate the proliferation capacity and tumorigenicity of HCC TC in IBSA samples, and the effects of TC reintroduction in patients with pre-existing HCC TCs.
由于存在肿瘤细胞重新引入的理论风险，术中血液回收自体输血（IBSA）在肝细胞癌（HCC）肝移植（LT）中的应用仍存在争议。目前评估肿瘤细胞存在情况的研究受到检测技术欠佳的限制。本研究旨在利用微流控技术分析HCC肝移植自体血液中肿瘤细胞的存在情况。
对2018年2月至2019年4月接受肝移植的HCC患者进行前瞻性研究。围手术期采集血样。使用微流控技术分离肿瘤细胞，并用抗体混合物染色进行确认。
共招募了15例HCC肝移植患者。所有受者术前的肿瘤特征均符合加利福尼亚大学旧金山分校（UCSF）标准。在从手术区域采集的所有自体血样中均检测到肿瘤细胞。经术中细胞洗涤系统（IOCS）冲洗后，5例患者未检测到肿瘤细胞，而10例患者检测到肿瘤细胞；其中2例在经过白细胞滤除器（LDF）过滤后肿瘤细胞仍呈阳性。
在HCC肝移植患者中使用IBSA时，单次使用LDF可降低肿瘤细胞重新引入的风险。未来的研究应评估IBSA样本中HCC肿瘤细胞的增殖能力和致瘤性，以及预先存在HCC肿瘤细胞的患者中肿瘤细胞重新引入的影响。
