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Intraoperative Blood Loss Is a Promoter of Early Tumor Recurrence in Liver Transplant Patients with High Risk Hepatocellular Carcinoma.

A. Kornberg,1 U. Witt,1 J. Kornberg,2 H. Friess,1 K. Müller,3 K. Thrum.4

1Surgery, Technical University, Munich, Germany
2Anesthesiology, Ludwig-Maximilians-University, Munich, Germany
3FSU, Jena, Germany
4Pathology, Helios-Klinikum, Berlin, Germany.

Meeting: 2016 American Transplant Congress

Abstract number: A186

Keywords: Hepatocellular carcinoma, Liver transplantation, Outcome, Tumor recurrence

Session Information

Date: Saturday, June 11, 2016

Session Name: Poster Session A: Liver - Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

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Background:

Currently, there is an increasing body of evidence that risk of early hepatocellular carcinoma (HCC) relapse following liver transplantation (LT) may be promoted by mechanisms related to ischemia-reperfusion injury (IRI). Intraoperative blood loss (IBL) is a trigger of pro-inflammatory and immunosuppressive processes. The aim of this trial was to analyze the impact of IBL on risk of early HCC relapse post-LT.

Methods:

106 liver transplant patients with HCC were analyzed. Pretransplant tumor staging included 18F-FDG positron emission tomography (PET) for assessing biological tumor aggressiveness (PET + versus PET – HCC). IBL was calculated ultimately post-LT. The impact of IBL along with other established clinical and pathologic variables on early (within 12 months) HCC recurrence after LT was assessed in uni- and multivariate analysis.

Results:

Sixty-seven patients demonstrated PET-negative HCC, while 39 patients had 18F-FDG-avid tumors on pretransplant PET. Twenty-five patients were suffering from HCC recurrence (23.6%), 19 within 12 months (82.6%). In univariate analysis, AFP level > 400IU/ml, donor age > 50y, HCC exceeding the Milan criteria, PET-positive tumors, total ischemia time > 450min, IBL > 1500ml, poor tumor grading, lymphovascular invasion and microvascular invasion (MVI) were related to early HCC relapse (P < 0.05). After multivariate analysis, only IBL > 1500ml (Hazard ratio [HR] = 14.8; P < 0.001) and MVI (HR = 13.6, P = 0.002) remained as independent predictors of early post-LT tumor recurrence. Increased IBL correlated with ischemia-reperfusion damage to the graft (aminotransferases) and systemic inflammatory state of the patient (C-reactive protein levels; P < 0.05). In patients with 18F-FDG non-avid HCC, IBL had no impact on outcome. However, in PET-positive HCC, IBL was identified as the only independent promoter of early HCC recurrence (HR = 10.8; P = 0.002). In this special subgroup, 5-year recurrence-free survival rate was 63% in patients with low, but 0% in those with high IBL (P < 0.001).

Conclusion:

Intraoperative blood loss is a strong predictor of early HCC recurrence post-LT, particularly in patients with high risk HCC. Thus, approaches of bleeding minimization could be essential for improving tumor-specific post-LT outcome in advanced HCC.

CITATION INFORMATION: Kornberg A, Witt U, Kornberg J, Friess H, Müller K, Thrum K. Intraoperative Blood Loss Is a Promoter of Early Tumor Recurrence in Liver Transplant Patients with High Risk Hepatocellular Carcinoma. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Kornberg A, Witt U, Kornberg J, Friess H, Müller K, Thrum K. Intraoperative Blood Loss Is a Promoter of Early Tumor Recurrence in Liver Transplant Patients with High Risk Hepatocellular Carcinoma. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/intraoperative-blood-loss-is-a-promoter-of-early-tumor-recurrence-in-liver-transplant-patients-with-high-risk-hepatocellular-carcinoma/. Accessed February 28, 2021.

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