title: Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients.
abstract: OBJECTIVE
  To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients.
  
  
  METHODS
  Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and χ(2) tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.
  
  
  RESULTS
  Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 ± 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 ± 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 ± 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival.
  
  
  CONCLUSIONS
  CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.
authors.affiliation: Division of Liver Transplantation Institute, Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey. akbulutsami@gmail.com
authors.forename: Sami
authors.initials: S
authors.lastname: Akbulut
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Volkan
authors.initials: V
authors.lastname: Ince
authors.forename: Dincer
authors.initials: D
authors.lastname: Ozgor
authors.forename: Koray
authors.initials: K
authors.lastname: Karabulut
authors.forename: Cengiz
authors.initials: C
authors.lastname: Eris
authors.forename: Huseyin Ilksen
authors.initials: HI
authors.lastname: Toprak
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Aydin
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D057725:Operative Blood Salvage / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Hepatocellular carcinoma; Intraoperative blood salvage autotransfusion; Liver transplantation; Recurrence; Tumor cell dissemination
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