Practice to minimize the use of blood products improve outcome after hepatic resection for hepatocellular carcinoma

Background/Aims: Because recent studies have reported that allogenic blood transfusion exerts negative immunomodulatory effects, we tried decreasing the use of blood products in perioperative management of hepatic resection since 2003. We retrospectively assessed the changes in our blood transfusion policy on hepatic resection for hepatocellular carcinoma (HCC). Methodology: Subjects were 78 patients who underwent hepatic resection for HCC at Jikei University Hospital. Patients were classified into 2 groups; early period (2000-2002, n=25), and late period (2003-2006, n=53). Perioperative findings including age, gender, hepatitis virus, preoperative ICGR15, Child's classification, tumor factor, type of resection, duration of operation, blood loss, the amount of peri-operative red cell concentration (RC) and fresh frozen plasma (FFP) transfusion, incidences of post-operative complication, as well as disease-free and overall survival were analyzed. Results: The amount of peri-operative RC (p=0.041) and FFP (p<0.001) transfusion in late period were significantly smaller and non-anatomical limited partial resection (p=0.004) in late period was greater than early period. The patients in late period had significantly better overall survival rate than those in early period (p < 0.001). Conclusions: Practice to minimize the use of blood products may improve patient's survival after hepatic resection for HCC.