title: Intraoperative blood salvage during liver transplantation in patients with hepatocellular carcinoma: efficiency of leukocyte depletion filters in the removal of tumor cells.
abstract: BACKGROUND
  Intraoperative blood salvage (IBS) reduces homologous transfusion in orthotopic liver transplantation (OLT), but may carry with it the risk of reinfusing tumor cells in patients with hepatocellular carcinoma (HCC). The use of leukocyte depletion filters (LDFs) for the removal of tumor cells is rarely reported in clinical OLT. The aims of this study were to evaluate the frequency of tumor cell contamination in surgical field during OLT for HCC recipients and to investigate the efficiency of additional LDFs for eliminating tumor cells from IBS.
  
  
  METHODS
  Thirty-two HCC patients with preoperatively elevated serum alpha-fetoprotein (AFP) underwent OLT. The blood from the surgical field was collected and processed by an autotransfusion device (Cell Saver 5), followed by 2 consecutive LDF filtrations. The HCC cells in IBS samples and filtered samples were determined using a nested RT-PCR technique to detect the AFP mRNA.
  
  
  RESULTS
  The shed blood samples from 20 (62.5%) of the 32 HCC patients were contaminated with HCC cells and 15 of them remained positive after Cell Saver processing. Patients within the Milan or UCSF criteria were less likely to have HCC cell contamination and the contaminated HCC cells were more likely to be removed by the Cell Saver in these patients as compared to other patients (P<0.01). After filtration through an additional LDF, most cases (13/15) became negative except for those with ruptured tumors (P<0.05).
  
  
  CONCLUSIONS
  Our results suggest that blood filtration with the LDF can efficiently remove tumor cells and the use of an additional LDF after use of the Cell Saver could markedly reduce the risk of tumor cell reintroduction during the OLT in HCC recipients with nonruptured tumors.
authors: Department of General Surgery, Key Laboratory of Multi-organ Transplantation of Ministry of Public Health, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.
authors: Ting-Bo
authors: TB
authors: Liang
authors: Dong-Lin
authors: DL
authors: Li
authors: Liang
authors: L
authors: Liang
authors: Jun-Jian
authors: JJ
authors: Li
authors: Xue-Li
authors: XL
authors: Bai
authors: Wei
authors: W
authors: Yu
authors: Wei-Lin
authors: WL
authors: Wang
authors: Yan
authors: Y
authors: Shen
authors: Min
authors: M
authors: Zhang
authors: Shu-Sen
authors: SS
authors: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D047589:Leukocyte Reduction Procedures; D008113:Liver Neoplasms / Q000235:genetics / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012333:RNA, Messenger / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D000509:alpha-Fetoproteins / Q000032:analysis / Q000235:genetics
chemical_list: D012333:RNA, Messenger; D000509:alpha-Fetoproteins