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Prognostic Impact of Intraoperative Blood Loss in Liver Transplant Patients with Advanced Hepatocellular Carcinoma
Arno Kornberg1, Ulrike Witt2, Jennifer Kornberg3
1Department of Surgery, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany ArnoKornberg@aol.com.
Insights
Minimizing intraoperative blood loss (IOBL) during liver transplant (LT) for liver cancer (HCC) significantly improves patient survival. Lower IOBL is crucial for better recurrence-free survival, especially for advanced HCC cases.
Area of Science:
- Hepatobiliary Surgery
- Transplant Oncology
- Surgical Outcomes Research
Background:
- Advanced hepatocellular carcinoma (HCC) poses challenges for liver transplant (LT) outcomes.
- Intraoperative blood loss (IOBL) is a potential factor influencing post-LT results in HCC patients.
Purpose of the Study:
- To investigate the association between intraoperative blood loss (IOBL) and patient outcomes after liver transplant (LT) for advanced hepatocellular carcinoma (HCC).
Main Methods:
- Retrospective analysis of 108 LT patients with HCC.
- Patients were staged using Milan criteria and 18F-FDG PET scan results.
- Outcomes were assessed based on IOBL levels (≤1,500 ml vs. >1,500 ml).
Main Results:
- Patients with low IOBL (≤1,500 ml) had significantly higher 3- and 5-year recurrence-free survival rates (91.9%) compared to those with high IOBL (>1,500 ml) (43.9% and 37.1%, respectively; p<0.001).
- Low IOBL was an independent predictor of better recurrence-free survival in patients with HCC exceeding Milan criteria (HR=3.66; p=0.029) and PET-positive tumors (HR=4.13; p=0.007).
Conclusions:
- Intraoperative bleeding is linked to a higher risk of tumor recurrence after LT for HCC.
- Reducing IOBL is recommended to enhance post-LT outcomes, particularly for patients with HCC not meeting standard criteria.
Background/Aim:
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).
Patients And Methods:
A total of 108 LT patients with HCC were retrospectively analyzed. They were all clinically staged according to the Milan criteria and to 18F-fluoro-D-glucose (18F-FDG) uptake on positron-emission tomography (PET).
Results:
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).
Conclusion:
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.
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