Assessment of blood-products use as predictor of pulmonary complications and surgical-site infection after hepatectomy for hepatocellular carcinoma
In perioperative management after hepatectomy, some patients require fresh frozen plasma (FFP) to treat coagulopathy associated with blood loss. However, several studies have suggested a correlation between blood products and pulmonary complications or surgical-site infection (SSI).
The subjects were 99 patients who underwent hepatectomy for hepatocellular carcinoma without plasma exchange for postoperative liver failure in the Department of Surgery, Jikei University Hospital, between January 2000 and December 2006. We investigated the association of 16 factors including age; gender; preoperative ICGR15; type of resection; concomitant resection of other digestive organs; duration of operation; blood loss; hepatitis virus status; postoperative minimum platelet count, maximum serum total bilirubin (max T-Bil), minimum serum albumin, or minimum prothrombin time; and the dose of red-blood-cell concentration (RC), FFP, platelet concentration, or albumin given in relation to postoperative pulmonary complications and SSI.
In univariate analysis, pulmonary complications were correlated with gender (P = 0.012), max T-Bil (P = 0.043), dose of RC given (P = 0.007), dose of FFP given (P < 0.001), and dose of albumin given (P < 0.001). In multivariate analysis, pulmonary complications were correlated with FFP given (P = 0.031) and albumin given (P = 0.020), while the incidence of SSI was not correlated with any factors.
Excessive FFP and albumin administration may cause pulmonary complications after hepatectomy.
- Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, et al. Surgery for small liver cancers. Semin Surg Oncol. 1993;9:294–304. CrossRef
- Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, et al. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery. 1994;115:303–9.
- Cunningham JD, Fong Y, Shriver C, Melendez JA, Marx WL, Blumgart LH. One hundred consecutive hepatic resections, blood loss, transfusion, and operative technique. Arch Surg. 1994;129:1050–6.
- Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187:620–5. CrossRef
- Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg. 1999;134:984–92. CrossRef
- Martin R, Jarnagin WR, Fong Y, Biernacki P, Blumgart LH, DeMatteo RP. The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: is there a standard for transfusion? J Am Coll Surg. 2003;196:402–9. CrossRef
- Bureau of Medicinal Safety, Ministry of Health and Welfare. Guidelines for administering blood preparations. Medical and Pharmaceutical Notification No. 715, 10 June 1999.
- Vamvakas EC, Carven JH. Exposure to allogeneic plasma and risk of postoperative pneumonia and/or infection in coronary artery bypass graft surgery. Transfusion. 2002;42:107–13. CrossRef
- Gajic O, Rana R, Mendez JL, Rickman OB, Lymp JF, Hubmayr RD, et al. Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion. 2004;44:1468–74. CrossRef
- Cochrane Injuries Group. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ. 1998;317:235–40.
- Wilkes MM, Navickis RJ. Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2001;135:149–64.
- Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. SAFE study investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56. CrossRef
- Vincent JL, Sakr Y, Reinhart K, Sprung CL, Gerlach H, Ranieri VM. Sepsis occurrence in acutely ill patients’ investigators. Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study. Crit Care. 2005;9:R745–54. CrossRef
- Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589–94. CrossRef
- Grindon AJ, Tomasulo PS, Bergin JJ, Klein HG, Miller JD, Mintz PD. The hospital transfusion committee: guidelines for improving practice. JAMA. 1985;253:540–3. CrossRef
- Contreras M, Ala FA, Greaves M, Jones J, Levin M, Machin SJ, et al. Guidelines for use of fresh frozen plasma. British Committee for Standards in Haematology, Working Party of the Blood Transfusion Task Force. Transfus Med. 1992;2:57–63. CrossRef
- Barnette RE, Fish DJ, Eisenstaedt RS. Modification of fresh-frozen plasma transfusion practices through educational intervention. Transfusion. 1990;30:253–7. CrossRef
- Shanberge JN, Quattrociocchi-Longe T. Analysis of fresh frozen plasma administration with suggestions for ways to reduce usage. Transfus Med. 1992;2:189–94. CrossRef
- Stehling L, Luban NL, Anderson KC, Sayers MH, Long A, Attar S, et al. Guidelines for blood utilization review. Transfusion. 1994;34:438–48. CrossRef
- Yanaga K, Kanematsu T, Takenaka K, Matsumata T, Yoshida Y, Sugimachi K. Hepatic resection for hepatocellular carcinoma in elderly patients. Am J Surg. 1988;155:238–41. CrossRef
- Nagao T, Inoue S, Goto S, Mizuta T, Omori Y, Kawano N, et al. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg. 1987;205:22–40. CrossRef
- Brunson ME, Alexander JW. Mechanisms of transfusion-induced immunosuppression. Transfusion. 1990;30:651–8. CrossRef
- Blajchman MA, Bordin JO. Mechanisms of transfusion-associated immunosuppression. Curr Opin Hematol. 1994;1:457–61.
- Blajchman MA. Immunomodulatory effects of allogeneic blood transfusions: clinical manifestations and mechanisms. Vox Sang. 1998;74(Suppl 2):315–9.
- Magee CC, Sayegh MH. Peptide-mediated immunosuppression. Curr Opin Immunol. 1997;9:669–75. CrossRef
- Krensky AM, Clayberger C. Structure of HLA molecules and immunosuppressive effects of HLA derived peptides. Int Rev Immunol. 1996;13:173–85. CrossRef
- Ashkenazi A, Dixit VM. Death receptors: signaling and modulation. Science. 1998;281:1305–8. CrossRef
- Pitti RM, Marsters SA, Lawrence DA, Roy M, Kischkel FC, Dowd P, et al. Genomic amplification of a decoy receptor for Fas ligand in lung and colon cancer. Nature. 1998;396:699–703. CrossRef
- Ghio M, Contini P, Mazzei C, Brenci S, Barberis G, Filaci G, et al. Soluble HLA class I, HLA class II and Fas ligand in blood components: a possible key to explain the immnomodulatory effects of allogeneic blood transfusions. Blood. 1999;93:1770–7.
- Puppo F, Contini P, Ghio M, Brenci S, Scudeletti M, Filaci G, et al. Soluble human MHC class I molecules induce soluble Fas ligand secretion and trigger apoptosis in activated CD8(+) Fas (CD95)(+) T lymphocytes. Int Immunol. 2000;12:195–203. CrossRef
- Puppo F, Ghio M, Contini P, Mazzei C, Indiveri F. Fas, Fas ligand, and transfusion immunomodulation. Transfusion. 2001;41:416–8. CrossRef
- Assessment of blood-products use as predictor of pulmonary complications and surgical-site infection after hepatectomy for hepatocellular carcinoma
Journal of Hepato-Biliary-Pancreatic Surgery
Volume 16, Issue 1 , pp 69-74
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Fresh frozen plasma
- Hepatocellular carcinoma
- Pulmonary complication
- Surgical-site infection
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato, Tokyo, 105-8461, Japan