ABSTRACT
BACKGROUND: Hepatocellular carcinoma (HCC) is a significant cause of oncologic mortality worldwide. Liver transplantation represents a curative option for patients with significant liver dysfunction and absence of metastases. However, this therapeutic option is associated with significant blood loss and frequently requires various transfusions and intraoperative blood salvage for autotransfusion (IBS-AT) with or without a leukocyte reduction filter. This study aimed to analyze available evidence on long-term oncologic outcomes of patients undergoing liver transplantation for HCC with and without IBS-AT. METHODS: Per PRISMA guidelines, a systematic review of keywords "Blood Salvage," "Auto-transfusion," "Hepatocellular carcinoma," and "Liver-transplant" was conducted in PubMed, EMBASE, and SCOPUS. Studies comparing operative and postoperative outcomes were screened and analyzed for review. RESULTS: Twelve studies totaling 1704 participants were included for analysis. Length of stay, recurrence rates, and overall survival were not different between IBS-AT group and non IBS-AT group. CONCLUSION: IBS-AT use is not associated with increased risk of recurrence in liver transplant for HCC even without leukocyte filtration. Both operative and postoperative outcomes are similar between groups. Comparison of analyzed studies suggest that IBS-AT is safe for use during liver transplant for HCC.
Subject(s)
Carcinoma, Hepatocellular , Irritable Bowel Syndrome , Liver Neoplasms , Liver Transplantation , Humans , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Blood Transfusion, Autologous/adverse effects , Liver Transplantation/adverse effects , Irritable Bowel Syndrome/etiology , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/surgery , Retrospective StudiesABSTRACT
La trasfusión de hemoderivados se utiliza con más frecuencia en pacientes con neoplasias hematológicas que en pacientes con tumores sólidos, y de forma variable en el caso de pacientes terminales con otro tipo de patologías. La anemia y trombocitopenia son frecuentes en este grupo diverso de pacientes, que reciben tratamientos hasta el final de la vida, siendo la transfusión de componentes sanguíneos, como los glóbulos rojos o las plaquetas, una intervención necesaria para el alivio de síntomas y mejoras en el estado clínico. Sin embargo, en pacientes con enfermedad terminal, los síntomas son de origen multifactorial y los valores hematológicos no necesariamente se convierte en un criterio para transfundir. No obstante, la evidencia científica que apoya que las transfusiones mejoren significativamente los síntomas de los pacientes paliativos aún no es concluyente.A pesar de que la literatura define algunas indicaciones para transfundir las dificultades, empiezan en el contexto de la selección del tipo de transfusión, la cantidad de las mismas y el fin de vida. En la literatura científica se encuentran diferentes comunicaciones que relacionan las últimas unidades de hemoderivados administrados, previo a la muerte del paciente; sin embargo, poco se encuentra con relación a criterios uniformes que apoyen la decisión al final de la vida y la relación riesgo beneficio no es clara.Las trasfusiones sanguíneas, además de ser procedimientos comunes en la práctica clínica, son terapias que generan riesgos y costes considerables para el sistema, por lo que la búsqueda de opciones alternas se hace imperativo a la hora de evitar terapias innecesarias.(AU)
Transfusion of blood products is used more frequently in patients with hematological malignancies than in patients with solid tumors, and variably in the case of terminally ill patients with other types of pathologies. Anemia and thrombocytopenia are frequent in this diverse group of patients, who receive treatments until the end of life, the transfusion of blood components, such as red blood cells or platelets, being a necessary intervention for the relief of symptoms and improvements in condition. clinical. However, in terminally ill patients, symptoms are multifactorial in origin and hematological values do not necessarily become a criterion for transfusing, however, the scientific evidence supporting that transfusions significantly improve the symptoms of palliative patients has not yet is conclusive.Although the literature defines some indications for transfusing difficulties, they begin in the context of the selection of the type of transfusion, the amount of the transfusion, and the end of life. In the scientific literature there are different reports that list the last units of blood products administered, prior to the death of the patient; however, little is found in relation to uniform criteria that support the decision at the end of life and the risk benefit ratio is not clear.Blood transfusions, in addition to being common procedures in clinical practice, are therapies that generate considerable risks and costs for the system, so the search for alternative options becomes imperative when it comes to avoiding unnecessary therapies.Patients with end-of-life transfusion needs generally have a history of known chronic disease; It is for this reason that the mobilization of individual and family resources becomes the challenge for healthcare personnel, since this will largely depend on the way in which the situation is dealt with and the links that are generated, so the approach must be carried out in an interdisciplinary way.(AU)
