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Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation
BACKGROUND: Several studies have investigated the effect of intraoperative blood loss (IBL) on recurrence of tumors. However, the independent effect of IBL on oncological outcome after liver transplantation (LT) for hepatocellular carcinoma (HCC) is unclear. METHODS: A total of 479 patients who unde...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608055/ https://www.ncbi.nlm.nih.gov/pubmed/26472203 http://dx.doi.org/10.1186/s12876-015-0364-5 |
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author | Liu, Bing Teng, Fei Fu, Hong Guo, Wen-Yuan Shi, Xiao-Min Ni, Zhi-Jia Gao, Xiao-Gang Ma, Jun Fu, Zhi-Ren Ding, Guo-Shan |
author_facet | Liu, Bing Teng, Fei Fu, Hong Guo, Wen-Yuan Shi, Xiao-Min Ni, Zhi-Jia Gao, Xiao-Gang Ma, Jun Fu, Zhi-Ren Ding, Guo-Shan |
author_sort | Liu, Bing |
collection | PubMed |
description | BACKGROUND: Several studies have investigated the effect of intraoperative blood loss (IBL) on recurrence of tumors. However, the independent effect of IBL on oncological outcome after liver transplantation (LT) for hepatocellular carcinoma (HCC) is unclear. METHODS: A total of 479 patients who underwent LT for HCC from January 2001 to December 2012 at our institution were enrolled in this retrospective study. Kaplan–Meier and Cox regression methods were used to assess the recurrence rate, as well as its risk factors. Stratified analysis was performed to further examine the effect of IBL on HCC recurrence according to different characteristics of tumors. We also investigated the independent risk factors for excessive IBL using logistic regression analysis. RESULTS: The median follow-up was 28 months (range, 1–131 months). Kaplan–Meier analysis with the log-rank test according to IBL at per liter intervals showed that IBL > 4 L was significantly associated with a higher recurrence rate (P < 0.001). Multivariate analysis identified that IBL > 4 L (P < 0.001; hazard ratio [HR] = 2.32, 95 % confidence interval [CI] = 1.60–3.36) was an independent risk factor for post-LT HCC recurrence, as well as age < 60 years, exceeding Milan criteria, α-fetoprotein levels > 400 ng/mL, and micro- and macrovascular invasion. IBL > 4 L (P < 0.001; HR = 2.45, 95 % CI = 1.64–3.66) was also independently associated with early (within 1 year) recurrence after LT. Furthermore, a significant correlation between IBL > 4 L and vascular invasion (P = 0.019) was found. IBL > 4 L was independently associated with HCC recurrence for patients with vascular invasion, but not for patients without vascular invasion. Finally, we found that the presence of ascites, model for end-stage liver disease score, and operation time were independent risk factors for IBL > 4 L. CONCLUSIONS: Excessive IBL is an independent predictor of HCC recurrence after LT, especially in patients with vascular invasion. |
format | Online Article Text |
id | pubmed-4608055 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-46080552015-10-17 Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation Liu, Bing Teng, Fei Fu, Hong Guo, Wen-Yuan Shi, Xiao-Min Ni, Zhi-Jia Gao, Xiao-Gang Ma, Jun Fu, Zhi-Ren Ding, Guo-Shan BMC Gastroenterol Research Article BACKGROUND: Several studies have investigated the effect of intraoperative blood loss (IBL) on recurrence of tumors. However, the independent effect of IBL on oncological outcome after liver transplantation (LT) for hepatocellular carcinoma (HCC) is unclear. METHODS: A total of 479 patients who underwent LT for HCC from January 2001 to December 2012 at our institution were enrolled in this retrospective study. Kaplan–Meier and Cox regression methods were used to assess the recurrence rate, as well as its risk factors. Stratified analysis was performed to further examine the effect of IBL on HCC recurrence according to different characteristics of tumors. We also investigated the independent risk factors for excessive IBL using logistic regression analysis. RESULTS: The median follow-up was 28 months (range, 1–131 months). Kaplan–Meier analysis with the log-rank test according to IBL at per liter intervals showed that IBL > 4 L was significantly associated with a higher recurrence rate (P < 0.001). Multivariate analysis identified that IBL > 4 L (P < 0.001; hazard ratio [HR] = 2.32, 95 % confidence interval [CI] = 1.60–3.36) was an independent risk factor for post-LT HCC recurrence, as well as age < 60 years, exceeding Milan criteria, α-fetoprotein levels > 400 ng/mL, and micro- and macrovascular invasion. IBL > 4 L (P < 0.001; HR = 2.45, 95 % CI = 1.64–3.66) was also independently associated with early (within 1 year) recurrence after LT. Furthermore, a significant correlation between IBL > 4 L and vascular invasion (P = 0.019) was found. IBL > 4 L was independently associated with HCC recurrence for patients with vascular invasion, but not for patients without vascular invasion. Finally, we found that the presence of ascites, model for end-stage liver disease score, and operation time were independent risk factors for IBL > 4 L. CONCLUSIONS: Excessive IBL is an independent predictor of HCC recurrence after LT, especially in patients with vascular invasion. BioMed Central 2015-10-15 /pmc/articles/PMC4608055/ /pubmed/26472203 http://dx.doi.org/10.1186/s12876-015-0364-5 Text en © Liu et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Liu, Bing Teng, Fei Fu, Hong Guo, Wen-Yuan Shi, Xiao-Min Ni, Zhi-Jia Gao, Xiao-Gang Ma, Jun Fu, Zhi-Ren Ding, Guo-Shan Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title | Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title_full | Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title_fullStr | Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title_full_unstemmed | Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title_short | Excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
title_sort | excessive intraoperative blood loss independently predicts recurrence of hepatocellular carcinoma after liver transplantation |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608055/ https://www.ncbi.nlm.nih.gov/pubmed/26472203 http://dx.doi.org/10.1186/s12876-015-0364-5 |
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