SP7.4 Autologous blood transfusion reduces the requirement for peri-operative allogenic blood transfusion in patients undergoing major hepatobiliary surgery

Abstract

Abstract Aims Major HPB surgery is associated with a high risk of major blood loss. We aimed to assess whether autologous transfusion of blood salvaged intra-operatively reduces the requirement for post-operative allogenic transfusion. This is clinically important because blood is a scarce resource and allogenic transfusion is associated with the potential for morbidity. Methods We analysed data from a prospective database of 501 patients undergoing major HPB resection (2015–2022). Patients who received cell salvage (n=264) were compared with those who did not (n=237). Non-autologous transfusion was assessed from the time of surgery to 5 days post-surgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with the need for allogenic blood transfusion. Results 32% of lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although cell salvage patients experienced significantly higher intra-operative blood loss compared with the non-cell salvage group (1360ml vs 971ml, p=0.0005), they received significantly less allogenic red blood cell units (1.5 vs 0.92 units/patient, p=0.03). In addition, more of the non-cell salvage patients required low-level transfusion (≤3 units). Use of cell salvage and correction of blood loss tolerance are both independently associated with avoidance of transfusion. There was no difference in major morbidity, 30 or 90-day mortality between the groups. Conclusions Use of cell salvage was associated with a reduction in allogenic blood transfusion. Further work is needed to understand whether this is a cost-effective means of reducing allogenic transfusion to support the routine use of intraoperative cell salvage in major HPB surgery.