Predeposit Autologous Plasma Donation in Liver Resection for Hepatocellular Carcinoma: Toward Allogenic Blood-Free Operations

BACKGROUND: The aim of this study was to evaluate the safety of predeposit autologous plasma donation (PAPD) and its efficacy in avoiding allogenic blood transfusions and albumin infusion in liver resection for hepatocellular carcinoma. STUDY DESIGN: PAPD was adopted in 20 patients in whom liver function remained within Child-Pugh's class A and an indocyanine green retention rate at 15 minutes was <= 15% (PAPD group). Up to 1,200 mL of autologous fresh frozen plasma was collected through three blood donation sessions. Allogenic blood transfusion rates, albumin infusion rates, and postoperative courses were compared between the PAPD group and a historic control (no PAPD) group (n = 36). RESULTS: Serum albumin levels after the last blood donation session were not significantly different from those before PAPD. The prothrombin activity even increased through the blood donation sessions (from median 80.9% [range 70.0% to 100%] to median 89.2% [range 71.2%, to 100%]; p < 0.001). Allogenic blood transfusion rate and albumin infusion rate were lower in the PAPD group than in the no PAPD group (11% versus 75%; p < 0.001 and 16% versus 47%; p = 0.038, respectively). Wastage rate of the autologous fresh frozen plasma products was 9%. CONCLUSIONS: PAPD was safe in patients with underlying liver disease and can be beneficial in simulating the liver synthetic function in advance of operation. Autologous fresh frozen plasma transfusion was effective for avoiding allogenic blood products in liver resection for hepatocellular carcinoma. (J Am Coll Surg 2009;209:206-214. (C) 2009 by the American College of Surgeons)