Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation

BMC Gastroenterology

Guo-Shan Ding¹  Zhi-Ren Fu¹  Jun Ma¹  Xiao-Gang Gao¹  Zhi-Jia Ni¹  Xiao-Min Shi¹  Wen-Yuan Guo¹  Hong Fu¹  Fei Teng¹  Bing Liu¹ 

[1] Department of Liver Surgery and Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China

关键词: Recurrence;    Intraoperative blood loss;    Liver transplantation;    Hepatocellular carcinoma;   

Others  :  1234372
DOI  :  10.1186/s12876-015-0364-5

 received in 2015-02-11, accepted in 2015-10-01,  发布年份 2015

【 摘 要 】

Background

Several studies have investigated the effect of intraoperative blood loss (IBL) on recurrence of tumors. However, the independent effect of IBL on oncological outcome after liver transplantation (LT) for hepatocellular carcinoma (HCC) is unclear.

Methods

A total of 479 patients who underwent LT for HCC from January 2001 to December 2012 at our institution were enrolled in this retrospective study. Kaplan–Meier and Cox regression methods were used to assess the recurrence rate, as well as its risk factors. Stratified analysis was performed to further examine the effect of IBL on HCC recurrence according to different characteristics of tumors. We also investigated the independent risk factors for excessive IBL using logistic regression analysis.

Results

The median follow-up was 28 months (range, 1–131 months). Kaplan–Meier analysis with the log-rank test according to IBL at per liter intervals showed that IBL > 4 L was significantly associated with a higher recurrence rate (P < 0.001). Multivariate analysis identified that IBL > 4 L (P < 0.001; hazard ratio [HR] = 2.32, 95 % confidence interval [CI] = 1.60–3.36) was an independent risk factor for post-LT HCC recurrence, as well as age < 60 years, exceeding Milan criteria, α-fetoprotein levels > 400 ng/mL, and micro- and macrovascular invasion. IBL > 4 L (P < 0.001; HR = 2.45, 95 % CI = 1.64–3.66) was also independently associated with early (within 1 year) recurrence after LT. Furthermore, a significant correlation between IBL > 4 L and vascular invasion (P = 0.019) was found. IBL > 4 L was independently associated with HCC recurrence for patients with vascular invasion, but not for patients without vascular invasion. Finally, we found that the presence of ascites, model for end-stage liver disease score, and operation time were independent risk factors for IBL > 4 L.

Conclusions

Excessive IBL is an independent predictor of HCC recurrence after LT, especially in patients with vascular invasion.

【 授权许可】

   
2015 Liu et al.

【 图 表 】

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