title: Prognostic Impact of Intraoperative Blood Loss in Liver Transplant Patients with Advanced Hepatocellular Carcinoma.
abstract: The aim of this retrospective study was to analyze the impact of intraoperative blood loss (IOBL) on outcome in liver transplant (LT) patients with advanced hepatocellular carcinoma (HCC).
  
  
  
  A total of 108 LT patients with HCC were retrospectively analyzed. They were all clinically staged according to the Milan criteria and to18F-fluoro-D-glucose (18F-FDG) uptake on positron-emission tomography (PET).
  
  
  
  Recurrence-free survival rates at 3 and 5 years post-LT were 91.9% and 91.9% among patients with low (≤1,500 ml) IOBL, and 43.9% and 37.1% in those with high (>1,500 ml) IOBL (log-rank p<0.001). Multivariate analysis demonstrated low IOBL to be an independent predictor of better recurrence-free survival in patients with HCC exceeding the Milan criteria (hazard ratio=3.66; p=0.029) and in those with PET-positive tumors (hazard ratio=4.13; p=0.007).
  
  
  
  Intraoperative bleeding is associated with increased likelihood of tumor recurrence following LT for HCC. Limiting IOBL should be considered for improving post-LT outcome, particularly in patients with HCC beyond standard criteria.
authors: Department of Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany ArnoKornberg@aol.com.
authors: Arno
authors: A
authors: Kornberg
authors: Department of Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors: Ulrike
authors: U
authors: Witt
authors: Department of Anaesthesiology, University Hospital Großhadern, Ludwig Maximilian University Munich, Munich, Germany.
authors: Jennifer
authors: J
authors: Kornberg
authors: Department of Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors: Güralp O
authors: GO
authors: Ceyhan
authors: Department of Surgery, University of Jena, Jena, Germany.
authors: Katharina
authors: K
authors: Mueller
authors: Department of Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
authors: Helmut
authors: H
authors: Friess
authors: Institute of Pathology, Helios Hospital Berlin, Berlin, Germany.
authors: Katharina
authors: K
authors: Thrum
mesh_terms: D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: 18F-FDG positron-emission tomography; Liver transplantation; Milan criteria; hepatocellular carcinoma; intraoperative blood loss; survival