Skip to main content

Advertisement

SpringerLink
Log in

Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The influence of allogenic blood transfusion on the postoperative outcomes of hepatocellular carcinoma (HCC) surgery remains controversial. This study aims to clarify the clinical impacts of perioperative allogenic blood transfusion on liver resection outcome in HCC patients.

Methods

We analyzed data collected over 5 years for 642 patients who underwent hepatectomy for HCC at one of the five university hospitals. We investigated the impact of allogenic blood transfusion on postoperative outcome after surgery in all patients and in 74 matched pairs, using a propensity score.

Results

Of the 642 patients, 198 (30.8%) received perioperative allogenic blood transfusion (AT group) and 444 (69.2%) did not (non-AT group). Overall survival was lower in the AT group than in the non-AT group in univariate (P < 0.001) and multivariate analyses (risk ratio 1.521, P = 0.011). After matching the different distributions using propensity scores, perioperative blood transfusion was found to be a poor prognostic factor for HCC patients.

Conclusions

In this multi-center study, perioperative blood transfusion was an independent factor for poor prognosis after curative surgery for primary HCC in the patient group and in pairs matched by propensity scores.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17.

    Article  PubMed  Google Scholar 

  2. Marubashi S, Dono K, Nagano H, Sugita Y, Asaoka T, Hama N, et al. Detection of AFP mRNA-expressing cells in the peripheral blood for prediction of HCC recurrence after living donor liver transplantation. Transpl Int. 2007;20:576–82.

    Article  CAS  PubMed  Google Scholar 

  3. Wall WJ, Marotta PJ. Surgery and transplantation for hepatocellular cancer. Liver Transpl. 2000;6:S16–22.

    Article  CAS  PubMed  Google Scholar 

  4. Hammad A, Kaido T, Ogawa K, Fujimoto Y, Uemura T, Mori A, et al. Liver transplantation for advanced hepatocellular carcinoma in patients with Child–Pugh A and B. Surg Today. 2016;46:248–54.

    Article  CAS  PubMed  Google Scholar 

  5. Nanashima A, Nagayasu T. Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today. 2016;46:398–404.

    Article  PubMed  Google Scholar 

  6. Cescon M, Vetrone G, Grazi GL, Ramacciato G, Ercolani G, Ravaioli M, et al. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg. 2009;249:995–1002.

    Article  PubMed  Google Scholar 

  7. Carlos M, Caveh M, Donat RS. Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index. Br Med Bull. 2004;70:15–28.

    Article  Google Scholar 

  8. Tomimaru Y, Wada H, Marubashi S, Kobayashi S, Eguchi H, Takeda Y, et al. Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma. World J Gastroenterol. 2010;16:5603–10.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jensen LS, Andersen AJ, Christiansen PM, Hokland P, Juhl CO, Madsen G, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg. 1992;79:513–6.

    Article  CAS  PubMed  Google Scholar 

  10. Foster RS, Costanza MC, Foster JC, Wanner MC, Foster CB. Adverse relationship between blood-transfusions and survival after colectomy for colon cancer. Cancer. 1985;55:1195–201.

    Article  PubMed  Google Scholar 

  11. Fong Y, Karpeh M, Mayer K, Brennan MF. Association of perioperative transfusions with poor outcome in resection of gastric adenocarcinoma. Am J Surg. 1994;167:256–60.

    Article  CAS  PubMed  Google Scholar 

  12. Crowe JP, Gordon NH, Fry DE, Shuck JM, Hubay CA. Breast cancer survival and perioperative blood transfusion. Surgery. 1989;106:836–41.

    CAS  PubMed  Google Scholar 

  13. van de Watering LM, Brand A, Houbiers JG, Klein Kranenbarg WM, Hermans J, van de Velde C. Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence. Br J Surg. 2001;88:267–72.

    Article  PubMed  Google Scholar 

  14. Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K. The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma. Cancer. 1993;72:1866–71.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    CAS  PubMed  Google Scholar 

  16. Takemura M, Osugi H, Higashino M, Takada N, Lee S, Kinoshita H. Effect of substituting allogenic blood transfusion with autologous blood transfusion on outcomes after radical esophagectomy for cancer. Ann Thorac Cardiovasc Surg. 2005;11:293–300.

    PubMed  Google Scholar 

  17. Kuroda S, Tashiro H, Kobayashi T, Oshita A, Amano H, Ohdan H. No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy. World J Surg. 2012;36:651–8.

    Article  PubMed  Google Scholar 

  18. Kwon AH, Matsui Y, Kamiyama Y. Perioperative blood transfusion in hepatocellular carcinomas: influence of immunologic profile and recurrence free survival. Cancer. 2001;91:771–8.

    Article  CAS  PubMed  Google Scholar 

  19. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757–63.

    Article  CAS  PubMed  Google Scholar 

  20. D’Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–81.

    Article  PubMed  Google Scholar 

  21. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.

    Article  PubMed  Google Scholar 

  22. Mizuguchi T, Kawamoto M, Meguro M, Hui TT, Hirata K. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014;44:1–10.

    Article  PubMed  Google Scholar 

  23. Liu L, Wang Z, Jiang S, Shao B, Liu J, Zhang S, et al. Perioperative allogeneic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One. 2013;8:e64261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Nanashima A, Abo T, Hamasaki K, Wakata K, Kunizaki M, Tou K, et al. Predictors of intraoperative blood loss in patients undergoing hepatectomy. Surg Today. 2013;43:485–93.

    Article  PubMed  Google Scholar 

  25. Sugita S, Sasaki A, Iwaki K, Uchida H, Kai S, Shibata K, et al. Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: a retrospective study. Eur J Surg Oncol. 2008;34:339–45.

    Article  CAS  PubMed  Google Scholar 

  26. Yamamoto J, Kosuge T, Saiura A, Sakamoto Y, Shimada K, Sano T, et al. Effectiveness of hepatic resection for early-stage hepatocellular carcinoma in cirrhotic patients: subgroup analysis according to Milan criteria. Jpn J Clin Oncol. 2007;37:287–95.

    Article  PubMed  Google Scholar 

  27. Asahara T, Katayama K, Itamoto T, Yano M, Hino H, Okamoto Y, et al. Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma. World J Surg. 1999;23:676–80.

    Article  CAS  PubMed  Google Scholar 

  28. Tomimaru Y, Eguchi H, Marubashi S, Wada H, Kobayashi S, Tanemura M, et al. Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma. World J Gastroenterol. 2011;17:3709–15.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Blumberg N, Heal JM. Effects of transfusion on immune function. Cancer recurrence and infection. Arch Pathol Lab Med. 1994;118:371–9.

    CAS  PubMed  Google Scholar 

  30. Tomimaru Y, Eguchi H, Wada H, Hama N, Kawamoto K, Kobayashi S, et al. Predicting the necessity of autologous blood collection and storage before surgery for hepatocellular carcinoma. J Surg Oncol. 2013;108:486–91.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan

    Hiroshi Wada, Hidetoshi Eguchi, Hiroaki Nagano, Yuichiro Doki & Masaki Mori

  2. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, 545-8585, Japan

    Shoji Kubo, Shigekazu Takemura & Shogo Tanaka

  3. Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, 589-8511, Japan

    Takuya Nakai & Yasuyuki Nakata

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan

    Masaki Kaibori, Kosuke Matsui, Morihiko Ishizaki & Masanori Kon

  5. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan

    Michihiro Hayashi, Fumitoshi Hirokawa, Koji Komeda & Kazuhisa Uchiyama

Authors
  1. Hiroshi Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetoshi Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroaki Nagano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shoji Kubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takuya Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaki Kaibori
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michihiro Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shigekazu Takemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shogo Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuyuki Nakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kosuke Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Morihiko Ishizaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Fumitoshi Hirokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Koji Komeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazuhisa Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Masanori Kon
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Yuichiro Doki
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Masaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidetoshi Eguchi.

Ethics declarations

Conflict of interest

Hiroshi Wada and his co-authors have no conflicts of interest to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wada, H., Eguchi, H., Nagano, H. et al. Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today 48, 73–79 (2018). https://doi.org/10.1007/s00595-017-1553-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-017-1553-3

Keywords

Search

Navigation