USE OF PREOPERATIVE AUTOLOGOUS BLOOD DONATION IN LIVER RESECTIONS FORCOLORECTAL METASTASES

BACKGROUND: Transfusion of allogeneic blood is associated with risks o f human immunodeficiency virus and hepatitis transmission, transfusion reactions, and other potential immunologic and infectious complicatio ns. To determine if predonation of autologous blood impacts upon trans fusion practice and clinical outcome following liver resection, clinic al records of 379 consecutive patients undergoing hepatic resection fo r metastases of colorectal cancer were identified from the prospective hepatobiliary database and reviewed. METHODS: Of the 379 hepatic rese ctions performed for colorectal metastases between January 1991 and Ja nuary 1996, 240 (63%) were hepatic lobectomy or trisegmentectomy. Thir ty-two percent of patients (123 of 379) agreed to preoperative blood d onation (POBD), and their clinical characteristics including age, preo perative hemoglobin, and operative mortality were comparable with thos e of patients without POBD, Liver resections were carried out using st andard vascular inflow and outflow control. Parenchymal transections w ere performed bluntly with maintenance of low central venous pressure (0 to 5 cm H2O). No vascular isolation or normovolemic hemodilution wa s used intraoperatively. All erythrocyte transfusions during the entir e hospital stay were considered and compared between the two groups. R ESULTS: Forty-five percent of patients (172 of 379) received blood tra nsfusions during or after liver resections, of which 61% (105 of 172) required only 1 or 2 units. Only 17% of the POBD group required alloge neic blood. This was significantly less than the group without POBD (4 3%, P < 0.01). There was no significant difference in the operative mo rtality (2.3% versus 4.9%, P = 0.2) and the median survival (50 versus 40 months, P = 0.3). CONCLUSIONS: Major hepatic resections using curr ent surgical techniques can be performed safely with low blood loss an d transfusion is required for only a minority of patients. POBD furthe r reduces transfusion requirement. (C) 1998 by Excerpta Medica, Inc.