Long-term results for living donor liver transplant recipients with hepatocellular carcinoma using intraoperative blood salvage with leukocyte depletion filter.

Massive intraoperative bleeding during liver transplantation often requires large amounts of blood products. The goal of this study was to investigate long-term outcomes of living donor liver transplantation (LDLT) recipients with hepatocellular carcinoma (HCC) who underwent intraoperative use of intraoperative blood salvage (IBS) and leukocyte depletion filter (LDF). In this study, we included 230 LDLT recipients with HCC from two transplantation centers, between February 2002 and December 2007. Group 1 patients (n = 121) underwent intraoperative IBS with LDF and group 2 patients (n = 109) did not. The amount of autotransfused, filtered red blood cells (RBCs) in group 1 was 1590.2 ± 1486.8 ml, which corresponded to 5.9 units of allogenic leukocyte-depleted RBCs saved. The incidences of renal dysfunction, postoperative bleeding, and urinary tract infection in group 2 were higher than in group 1 (P < 0.05). Recurrence-free survival rates for 1, 3, and 5 years were 91.3%, 83.3%, and 83.3%, respectively, in group 1, and 84.6%, 79.0%, and 77.4%, respectively, in group 2 (P = 0.314). IBS using LDF does not increase the risk of cancer recurrence during LDLT for recipients with HCC. Therefore, the use of IBS with LDF appears to be safe for LDLT recipients with HCC.