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Blood Transfusion is Associated with Recurrence of Hepatocellular Carcinoma After Hepatectomy in Child–Pugh Class A Patients

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Abstract

Introduction

Previous reports have indicated an association between blood transfusion and prognosis of hepatocellular carcinoma (HCC) after hepatectomy. However, clinicopathological biases were not adjusted in these studies. We aimed to clarify the effect of blood transfusions in patients with HCC and Child–Pugh class A after hepatectomy by using inverse probability of treatment weighting (IPTW) analysis for selection bias control.

Materials and methods

We enrolled 479 patients with primary HCC and Child–Pugh class A retrospectively (91 transfused and 388 nontransfused patients) who underwent curative hepatectomy. After adjusting for different covariate distributions for both groups by IPTW, we analyzed the prognostic outcomes.

Results

In the unweighted analyses, overall survival (OS) rate of transfused patients was significantly lower than in nontransfused patients (P < 0.0001). Recurrence-free survival (RFS) rate of transfused patients was significantly lower than that of nontransfused patients (P = 0.0024). Multivariate analysis showed that blood transfusion was an independent prognostic factor of OS and RFS. The different distributive covariates between the two groups were age, presence of liver cirrhosis, serum level of alpha-fetoprotein, maximum tumor diameter, and amount of intraoperative blood loss. After IPTW by these covariates, OS rate of transfused patients was not significantly lower than those of nontransfused patients, whereas RFS rate of transfused patients remained significantly lower than those of nontransfused patients (P = 0.038, adjusted HR 1.45; 95 % CI 1.0–2.1).

Conclusions

These results suggest that blood transfusion was associated with recurrence of HCC after hepatectomy in patients with HCC and Child–Pugh class A.

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Abbreviations

HCC:

Hepatocellular carcinoma

IPTW:

Inverse probability of treatment weighting

OS:

Overall survival

RFS:

Recurrence-free survival

AFP:

alpha-Fetoprotein

ICG-R15:

Indocyanine green retention rate at 15 min

HCV:

Hepatitis C virus

TRIM:

Transfusion-related immunomodulation

HR:

Hazard ratio

CI:

Confidence interval

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Acknowledgments

The authors thank the co-medical staff (O.T., S.Y., and M.T.) in Hiroshima Red Cross Hospital and Atomic Bomb Survivor Hospital for helping with the data collection.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. The Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan

    Noboru Harada, Takashi Maeda, Hiroto Kayashima & Teruyoshi Ishida

  2. The Department of Surgery and Medical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Ken Shirabe & Yoshihiko Maehara

Authors
  1. Noboru Harada
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  2. Ken Shirabe
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  3. Takashi Maeda
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  4. Hiroto Kayashima
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  5. Teruyoshi Ishida
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  6. Yoshihiko Maehara
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Corresponding author

Correspondence to Noboru Harada.

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Harada, N., Shirabe, K., Maeda, T. et al. Blood Transfusion is Associated with Recurrence of Hepatocellular Carcinoma After Hepatectomy in Child–Pugh Class A Patients. World J Surg 39, 1044–1051 (2015). https://doi.org/10.1007/s00268-014-2891-6

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  • DOI: https://doi.org/10.1007/s00268-014-2891-6

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