The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review.
Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature.



The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion. Outcomes were mortality, complications, and cancer survival.



Twenty-two studies involving 6832 patients were included. All studies were retrospective, with no clinical trials. No studies were scored as low risk of bias. The overall proportion of patients transfused was 38.3%. After multivariate analysis, 1 of 5 studies demonstrated an association between transfusion and increased mortality; 5 of 6 demonstrated an association between transfusion and increased complications; and 10 of 18 demonstrated an association between transfusion and decreased cancer survival.



This review supports the evidence linking perioperative blood transfusions to negative outcomes. The most convincing association was with post-operative complications, some association with long-term cancer outcomes, and no convincing association with mortality. These findings support the initiation, and further study, of restrictive transfusion protocols.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Sean
S
Bennett
Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada.
Laura K
LK
Baker
Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Guillaume
G
Martel
The Ottawa Hospital, Ottawa, ON, Canada.
Risa
R
Shorr
Department of Surgery, The Ohio State University, Columbus, OH, USA.
Timothy M
TM
Pawlik
The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Alan
A
Tinmouth
The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Daniel I
DI
McIsaac
Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Paul C
PC
Hébert
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Paul J
PJ
Karanicolas
The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Lauralyn
L
McIntyre
Department of Anesthesiology, Université Laval, Québec, QC, Canada.
Alexis F
AF
Turgeon
Department of Surgery, McGill University, Montréal, QC, Canada.
Jeffrey
J
Barkun
Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Dean
D
Fergusson
D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome