Prognostic Impact of Intraoperative Blood Loss in Liver Transplant Patients with Advanced Hepatocellular Carcinoma

Background/Aim: The aim of this retrospective study was to analyze the impact of intraoperative blood loss (IOBL) on outcome in liver transplant (LT) patients with advanced hepatocellular carcinoma (HCC). Patients and Methods: A total of 108 LT patients with HCC were retrospectively analyzed. They were all clinically staged according to the Milan criteria and to F-18-fluoro-D-glucose (F-18-FDG) uptake on positron-emission tomography (PET). Results: Recurrence-free survival rates at 3 and 5 years post-LT were 91.9% and 91.9% among patients with low (<= 1,500 ml) IOBL, and 43.9% and 37.1% in those with high (>1,500 ml) IOBL (log-rank p<0.001). Multivariate analysis demonstrated low IOBL to be an independent predictor of better recurrence-free survival in patients with HCC exceeding the Milan criteria (hazard ratio=3.66; p=0.029) and in those with PET-positive tumors (hazard ratio=4.13; p=0.007). Conclusion: Intraoperative bleeding is associated with increased likelihood of tumor recurrence following LT for HCC. Limiting IOBL should be considered for improving post-LT outcome, particularly in patients with HCC beyond standard criteria.