Is hepatocellular carcinoma viability important when using intraoperative blood salvage during liver transplantation?

Abstract

Background: Intraoperative blood salvage and autotransfusion (IBS) is considered safe in liver transplantation for hepatocellular carcinoma (HCC). However, little is known about the potential impact of the viable tumor burden on recurrence and survival. This study investigated whether the presence of viable HCC during transplantation with IBS impacted HCC recurrence and patient survival. Methods: A retrospective study was conducted of liver transplants for patients with HCC in Atlantic Canada between 2005 and 2017. Information on locoregional treatment, IBS volume, and explant pathology was collected. Variables were analyzed to identify associations with HCC recurrence and patient survival via parametric and non-parametric tests. The Kaplan-Meier and log-rank tests were used to compare survival. Results: Sixty-eight subjects were included. IBS was used in 44.1% of the patients, with a median volume of 711 mL. Radiographic total tumor volume correlated well with the actual tumor viable volume (TVV) (Pearson’s r = 0.82, P < 0.01), but was overestimated by 50% when compared to the actual tumor burden on explant pathology. HCC recurrence was observed in 6 patients, and IBS was used in 5. Patients receiving IBS also had more viable tumors, but not a greater TVV. Overall patient survival did not exhibit significant differences according to the presence of viable tumors, vascular invasion, or satellitosis. Conclusion: IBS during liver transplantation was associated with significantly higher HCC recurrence in our limited series. However, the volume of viable HCC during the transplant procedure was not associated with any difference in tumor recurrence or patient survival.

Keywords: Carcinoma, hepatocellular, Liver transplantation, Operative blood salvage, Recurrence, Survival