Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ann Surg. 2022 Aug 1;276(2):239-245. doi: 10.1097/SLA.0000000000005476. Epub 2022 Jul 6.
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.
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.
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.
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).
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.
评估术中血液回收（IBS）对接受肝移植的肝细胞癌（HCC）患者肿瘤复发时间、无病生存率和总生存率的影响，以评估 IBS 的安全性。
IBS 非常有效地减少了异体输血的使用。然而，由于担心恶性细胞播散，IBS 在 HCC 患者肝移植中的安全性受到质疑。
通过 8 个数据库进行了截至 2021 年 6 月的全面检索。使用 Robins-I 工具评估纳入研究的方法学质量。使用通用倒数方差法进行荟萃分析，计算无病生存率、HCC 复发和总生存率的汇总风险比（HR）。
纳入了 9 项研究（n=1997，IBS n=1200，非-IBS n=797）。肝移植期间使用 IBS 与无病生存率受损无关[HR=0.90，95%置信区间（CI）=0.66-1.24，P=0.53，IBS n=394，非-IBS n=329]，与 HCC 复发增加无关（HR=0.83，95%CI=0.57-1.23，P=0.36，IBS n=537，非-IBS n=382），与总生存率受损无关（HR=1.04，95%CI=0.79-1.37，P=0.76，IBS n=495，非-IBS n=356）。
根据现有观察数据，在 HCC 患者肝移植期间使用 IBS 不会导致无病生存率受损、HCC 复发增加或总生存率受损。因此，在 HCC 患者肝移植期间使用 IBS 是一种安全的手术。
