Decrease in the Risk of Posttransplant Hepatocellular Carcinoma Recurrence After the Conversion to Prestorage...

Area of Science:

• Transplantation immunology
• Hematology
• Oncology

Background:

• Prestorage leukoreduction removes more leukocyte-derived immunomodulatory molecules from red blood cells (RBCs) compared to poststorage leukoreduction.
• Institutions are transitioning from poststorage to prestorage leukoreduction for RBC transfusions in liver transplant recipients.

Purpose of the Study:

• To evaluate the impact of switching from poststorage to prestorage leukoreduction on the risk of posttransplant hepatocellular carcinoma (HCC) recurrence.
• To assess the safety and efficacy of prestorage leukoreduction in liver transplant recipients.

Main Methods:

• A propensity score-matched analysis compared 83 patients receiving poststorage-leukoreduced RBCs with 83 patients receiving prestorage-leukoreduced RBCs.
• The study included 220 patients undergoing living-donor liver transplantation for HCC.
• Overall HCC recurrence was the primary outcome, with survival analysis accounting for death as a competing risk.

Main Results:

• The 5-year HCC recurrence probability was 18.1% with prestorage leukoreduction versus 33.7% with poststorage leukoreduction (HR, 0.52; P=0.040).
• Multivariable analysis confirmed prestorage leukoreduction significantly lowered recurrence risk (HR, 0.29; P<0.001) and overall death risk (HR, 0.51; P=0.049).
• Subgroup analyses also demonstrated significantly lower recurrence risk with prestorage leukoreduction.

Conclusions:

• Prestorage leukoreduction may reduce the risk of HCC recurrence in liver transplant recipients receiving allogeneic RBCs.
• The findings support the adoption of prestorage leukoreduction to improve outcomes for liver transplant patients.