Brief Article
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World J Gastroenterol. Mar 14, 2013; 19(10): 1625-1631
Published online Mar 14, 2013. doi: 10.3748/wjg.v19.i10.1625
Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients
Sami Akbulut, Cuneyt Kayaalp, Mehmet Yilmaz, Volkan Ince, Dincer Ozgor, Koray Karabulut, Cengiz Eris, Huseyin Ilksen Toprak, Cemalettin Aydin, Sezai Yilmaz
Sami Akbulut, Cuneyt Kayaalp, Mehmet Yilmaz, Volkan Ince, Dincer Ozgor, Koray Karabulut, Cengiz Eris, Cemalettin Aydin, Sezai Yilmaz, Division of Liver Transplantation Institute, Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
Huseyin Ilksen Toprak, Department of Anesthesiology, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
Author contributions: Yilmaz S, Kayaalp C and Aydin C performed the surgical procedure; Akbulut S, Ozgor D, Ince V and Yilmaz M wrote the article and performed literature review, including a comprehensive literature search; Akbulut S Eris C, Kayaalp C and Toprak HI designed the study and wrote the article; Toprak HI provided the CATS usage information; Karabulut K performed the statistical analysis.
Correspondence to: Sami Akbulut, MD, Division of Liver Transplantation Institute, Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey. akbulutsami@gmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410036
Received: October 27, 2012
Revised: December 25, 2012
Accepted: January 11, 2013
Published online: March 14, 2013
Processing time: 138 Days and 0.8 Hours
Abstract

AIM: 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 χ2 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.

CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.

Keywords: Liver transplantation; Hepatocellular carcinoma; Intraoperative blood salvage autotransfusion; Recurrence; Tumor cell dissemination