title: Liver transplantation for hepatocellular carcinoma--is there a risk of recurrence caused by intraoperative blood salvage autotransfusion?
abstract: OBJECTIVE
  The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC).
  
  
  METHODS
  In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group).
  
  
  RESULTS
  Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group.
  
  
  CONCLUSIONS
  Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.
authors: Department of Transplantation and Hepatobiliary Surgery, University Medical Centre, Johannes Gutenberg University, Mainz, Germany. daniel.foltys@unimedizin-mainz.de
authors: D
authors: D
authors: Foltys
authors: T
authors: T
authors: Zimmermann
authors: M
authors: M
authors: Heise
authors: M
authors: M
authors: Kaths
authors: A
authors: A
authors: Lautem
authors: G
authors: G
authors: Wisser
authors: N
authors: N
authors: Weiler
authors: M
authors: M
authors: Hoppe-Lotichius
authors: T
authors: T
authors: Hansen
authors: G
authors: G
authors: Otto
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D009360:Neoplastic Cells, Circulating; D057725:Operative Blood Salvage / Q000009:adverse effects*; D012307:Risk Factors