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

BMC Gastroenterology

Research Article

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

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

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

DOI  :  10.1186/s12876-015-0364-5

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

来源: Springer

【 摘 要 】

BackgroundSeveral 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.MethodsA 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.ResultsThe 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.ConclusionsExcessive IBL is an independent predictor of HCC recurrence after LT, especially in patients with vascular invasion.

【 授权许可】

CC BY   
© Liu et al. 2015