Perioperative Allogenenic Blood Transfusion Is Associated with Worse Clinical Outcomes for Hepatocellular Carcinoma: A Meta-Analysis

Background and Objective: The impact of perioperative allogenenic blood transfusion (ABT) on clinical outcomes for hepatocellular carcinoma (HCC) is conflicting and unclear. The aim of this meta-analysis is to evaluate the association between ABT and HCC clinical outcomes. Outcomes evaluated were all-cause death, tumor recurrence and postoperative complications. Methods: Relevant articles were identified through MEDLINE search (up to November 2012). Meta-analyses were performed by using the fixed or random effect models. Study heterogeneity was assessed by Q-test and I-2 test. Publication bias was evaluated by funnel plots, Egger's and Begg's test. Results: A total of 5635 cases from 22 studies finally met our inclusion criteria. Meta-analysis indicated HCC patients with ABT had an increased risk of all-cause death at 3 and 5 years after surgery (respectively: OR = 1.92, 95% CI, 1.61-2.29, P<0.001; OR = 1.60, 95% CI, 1.47-1.73, P<0.001) compared with those without ABT. The risk of tumor recurrence was significantly higher for ABT cases at 1, 3 and 5 years (respectively: OR = 1.70, 95% CI, 1.38-2.10, P<0.001; OR = 1.22, 95% CI, 1.08-1.38, P<0.001; OR = 1.16, 95% CI, 1.08-1.24, P<0.001). The HCC cases with ABT significantly increased postoperative complications occurrence compared with non-ABT cases (OR = 1.78,95% CI, 1.34-2.37, P<0.001). Conclusions: The findings from the current meta-analysis demonstrated that ABT was associated with adverse clinical outcomes for HCC patients undergoing surgery, including increased death, recurrence and complications. Therefore, ABT should not be performed if possible.