Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients

Abstract

Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.

Keywords: Intraoperative blood salvage autotransfusion; Liver transplantation; Hepatocellular carcinoma; Leukocyte depletion filters; Allogeneic blood transfusion

Core tip: The use of intraoperative blood salvage autotransfusion (IBSA) in hepatocellular carcinoma (HCC) patients undergoing liver transplantation is controversial as it may reinfuse salvaged blood contaminated by tumor cells. In this article, we reviewed the relevant literature and tried to address the critical questions about IBSA. The available data indicate that IBSA is safe in liver transplantation for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.