title: Practice to minimize the use of blood products improve outcome after hepatic resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  Because recent studies have reported that allogenic blood transfusion exerts negative immunomodulatory effects, we tried decreasing the use of blood products in perioperative management of hepatic resection since 2003. We retrospectively assessed the changes in our blood transfusion policy on hepatic resection for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Subjects were 78 patients who underwent hepatic resection for HCC at Jikei University Hospital. Patients were classified into 2 groups; early period (2000-2002, n=25), and late period (2003-2006, n=53). Perioperative findings including age, gender, hepatitis virus, preoperative ICGR15, Child's classification, tumor factor, type of resection, duration of operation, blood loss, the amount of peri-operative red cell concentration (RC) and fresh frozen plasma (FFP) transfusion, incidences of post-operative complication, as well as disease-free and overall survival were analyzed.
  
  
  RESULTS
  The amount of perioperative RC (p=0.041) and FFP (p<0.001) transfusion in late period were significantly smaller and non-anatomical limited partial resection (p=0.004) in late period was greater than early period. The patients in late period had significantly better overall survival rate than those in early period (p<0.001).
  
  
  CONCLUSIONS
  Practice to minimize the use of blood products may improve patient's survival after hepatic resection for HCC.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Gocho
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Ito
authors.forename: Taro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsutsui
authors.forename: Tomonori
authors.initials: T
authors.lastname: lida
authors.forename: Michinori
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.forename: Shoichi
authors.initials: S
authors.lastname: Hirohara
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome