title: Can a leukocyte depletion filter (LDF) reduce the risk of reintroduction of hepatocellular carcinoma cells?
abstract: During liver transplantation for hepatocellular carcinoma (HCC) patients, HCC could theoretically be introduced into the systemic circulation when salvaged blood is used with an autotransfusion device. Several reports have shown that some types of leukocyte depletion filters (LDFs) could completely reduce the risk for reintroducing some types of tumor cells. In this study, we tested the ability of the LDF (RCEZ1T, Pall Biomedical Co, NY, USA) to reduce the risk for reintroducing HCC cells in vitro by using a very sensitive detection method. We divided the test group into 6 groups: group I was 10 cells, group II was 20 cells, group III was 2 x 10(3) cells, group IV was 2 x 10(5) cells, group V was 2 x 10(6) cells, and group VI was 2 x 10(7) cells. The counted cells in 200 mL saline were passed through the RCEZ1T using the force of gravity. To identify the presence of cells, the pellet was resuspended, and polymerase chain reaction (PCR) was performed. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), a housekeeping gene, was used as a primer. In groups I and II, the HCC cells were completely filtered in all experiments. However, in groups III, IV, and V, the HCC cells were not completely filtered in a few of the repeated experiments, with the unfiltered rate of tumor cells being between 8% and 20%. In group VI, the HCC cells were not completely filtered in all the repeated experiments. In conclusion, the RCEZ1T filter markedly reduced the risk for reintroduction of HCC cells. However, at high HCC cell load the filter cannot completely remove all the tumor cells. Further studies are required to assess the impact in clinical settings.
authors.affiliation: Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Gwak
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Shi Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Jihyun
authors.initials: J
authors.lastname: Lee
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hwan Hyo
authors.initials: HH
authors.lastname: Lee
authors.forename: Jean Wan
authors.initials: JW
authors.lastname: Park
authors.forename: Gaab Soo
authors.initials: GS
authors.lastname: Kim
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D045744:Cell Line, Tumor; D005374:Filtration / Q000379:methods*; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases / Q000032:analysis / Q000235:genetics; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012680:Sensitivity and Specificity
chemical_list: D005987:Glyceraldehyde-3-Phosphate Dehydrogenases