Effect of Preoperative Autologous Blood Storage in Major Hepatectomy for Perihilar Malignancy

Objective: To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy. Summary Background Data: Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit of major hepatectomy has been controversial. Methods: This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition). Results: Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n=68, non-storage group n=70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n=60, non-storage group n=53). Surgical procedures, operative time, and blood loss were not significantly different between the 2 groups. The incidence of PHLF was comparable [blood storage group n=10 (17%), non-storage group n=10 (19%); P =0.760]. There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs 72%, P =0.997) and median duration of hospital stay (25 vs 29 days, P =0.277). Conclusions: Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.