Oncologic Outcomes of Intraoperative Autologous Blood Transfusion for Major Oncologic Resection

Intraoperative autologous blood transfusion (IABT) is contraindicated during oncologic resection owing to concern for metastasis. However, there is a paucity of data to substantiate this claim, and the true risk of IABT in patients with cancer remains unknown.

We identified patients who underwent oncologic resection with IABT during 2010-2021 at our institution. The primary outcome was early metastasis. A subgroup analysis of patients who underwent liver transplants for malignancy was conducted using inverse probability of treatment weighting to compare survival between those who received autologous and allogeneic transfusions.

Of 444 patients, the most common diagnoses were hepatocellular carcinoma (235, 52.9%), cholangiocarcinoma (68, 15.3%), and renal cell carcinoma (18, 4.1%). The median volume of autologous blood transfused was 661 mL (interquartile range (IQR) 337-1491 mL). A total of 7 patients (1.6%) experienced distant recurrence within 90 days, and 35 (7.9%) within 1 year. Of the seven patients with early distant recurrence, only one had metastasis not attributable to preoperative factors. In a subgroup analysis of patients undergoing liver transplant for malignancy, 299 patients who received IABT were compared with 107 patients who received allogeneic transfusion. After adjusting for cancer type, age, sex, estimated blood loss, model for end-stage liver disease (MELD) score, stage, and allograft type, IABT was not associated with overall survival (OS) [adjusted hazard ratio (AHR) 1.30 (95% confidence interval (CI) 0.82-2.03), p = 0.241] or recurrence-free survival (RFS) [AHR 1.15 (95% CI 0.77-1.73), p = 0.498].

IABT does not appear to be associated with early recurrence in patients undergoing oncologic resection. IABT should be investigated as a possible alternative to massive transfusion of allogeneic blood during oncologic resection.