Effect of intraoperative autotransfusion use during liver transplantation for hepatocellular carcinoma on recurrence-free survival: comparative study with propensity score matching

Background Intraoperative autotransfusion remains underutilized in high-risk haemorrhagic oncological procedures, particularly in liver transplantation for hepatocellular carcinoma. This is because of the theoretical risk of tumour cell reinfusion and dissemination, potentially leading to reduced recurrence-free survival. The aim of this study was to evaluate the impact of intraoperative autotransfusion on recurrence-free survival during liver transplantation for hepatocellular carcinoma. Methods This was a retrospective study of patients receiving liver transplantation for hepatocellular carcinoma with or without intraoperative autotransfusion between 1 January 2011 and 1 January 2020 at five French hospitals, of which one used autotransfusion and four did not. Propensity score matching was used to match the cohorts with and without autotransfusion. The primary endpoint was 5-year recurrence-free survival. Results Some 113 patients in the study cohort (autotransfusion) were compared with 441 patients in the control cohort. The median volume of autotransfused blood was 1500 ml. Median follow-up was 84.6 months. There was no significant difference in 5-year recurrence-free survival between the cohorts (69.7% in control cohort versus 66.3% in study cohort; P = 0.241). After matching patients based on oncological criteria, the difference remained non-significant, with a 5-year recurrence-free survival rate of 67.1% in the study cohort and 77.6% in the control cohort (P = 0.174). Conclusion The use of autotransfusion during liver transplantation for hepatocellular carcinoma was not associated with recurrence-free survival.