Oncologic Safety of Irradiated-only Autologous Blood Transfusion in Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Cohort Study

BACKGROUND: Liver transplantation for hepatocellular carcinoma (HCC) is highly transfusion-demanding, and intraoperative cell salvage is used to limit allogeneic blood exposure. This study aimed to assess the oncologic safety of transfusion of irradiated-only autologous red blood cells during liver transplantation for HCC. METHODS: This single-center retrospective cohort included all patients who underwent liver transplantation for HCC between 2010 and 2022. Among the 135 patients, 97 received autologous transfusion of irradiated red blood cells collected through intraoperative cell salvage; the remaining 38 did not. No leukocyte depletion filters were used. The primary outcome was HCC recurrence; secondary outcomes were overall survival and transfusion requirements. RESULTS: The median follow-up time was 9.7 y. HCC recurrence occurred in 15.5% of patients in the autotransfusion group compared with 21.1% in the nonautotransfusion group ( P = 0.44). Kaplan-Meier analyses revealed no significant differences in recurrence-free or overall survivals between the 2 groups. Multivariable Cox regression adjusted for the Model for End-Stage Liver Disease score, tumor burden, Milan criteria, and microvascular invasion revealed that autotransfusion was not associated with recurrence or mortality. Patients in the autotransfusion group had significantly higher exposure to allogeneic blood products. CONCLUSIONS: Intraoperative autotransfusion of irradiated red blood cells without leukocyte depletion filters appears oncologically safe during liver transplantation for HCC, although the single-center, retrospective design and small control group warrant cautious interpretation and confirmation in larger multicenter studies. As tertiary transplant centers already use blood irradiators for immunocompromised patients, these findings support irradiation as a practical alternative to filtration.