Safety and outcomes of hemodilutional autologous transfusion in intermediate- to advanced-level liver resection: a prospective observational study

Abstract Purposes This prospective observational study evaluated the safety and perioperative outcomes of hemodilutional autologous transfusion (HAT) in patients undergoing intermediate- to advanced-level liver resection (LR). Methods Between 2022 and 2023, 50 patients scheduled for intermediate- to advanced-level LR were prospectively enrolled. The primary endpoint was the rate of intraoperative allogeneic blood transfusion. Secondary endpoints included total intraoperative blood loss, postoperative complications, postoperative allogeneic transfusion rate, and post-hepatectomy liver failure. Safety analyses of HAT-related adverse events were also performed. A historical cohort of 71 patients who met the identical eligibility criteria between 2020 and 2021 was used for the sensitivity analyses. Results Of the 50 patients, 48 underwent protocol-defined LR with HAT and were included in the analysis. The intraoperative allogeneic transfusion rate was 6.3%, and no HAT-related adverse events were observed. In sensitivity analyses using a historical cohort, no significant differences were observed in the primary and secondary endpoints. Among patients with massive intraoperative bleeding (≥ 1,000 mL), the prospective cohort tended to show a lower perioperative transfusion rate than the historical cohort (37.5% vs. 78.6%, P = 0.054). Conclusion No clinically overt HAT-related adverse events were observed; however, the efficacy of HAT remains unproven and should be evaluated in future studies.