Using Cell Saver in liver transplantation: Analysis of the risk of bacterial contamination and cost-effectiveness

Abstract

Background: Liver transplantation is associated with substantial intraoperative blood loss and frequently requires extensive transfusion. Autologous blood transfusion (ABT) using the Cell Saver is frequently preferred to reduce the need for allogeneic transfusion. Autologous transfusion provides advantages in reducing immunologic and infectious risks; however, concerns remain regarding bacterial contamination and cost-effectiveness. Methods: This retrospective study included 197 patients underwent liver transplantation from January 2023 to July 2024. The Cell Saver was routinely used in all cases. Demographic data, transfusion volumes, and culture results from salvaged blood were analyzed. Bacterial contamination of the Cell Saver system-processed blood was the primary outcome. Transfusion requirements and cost analysis were secondary outcomes. Results: The mean autologous transfusion volume was 788.4 mL, with 1.7 units of erythrocytes and 1.2 units of plasma transfused. Autotransfusion blood cultures were positive in 53.4 % of the 73 tested patients (nonenteric, 34; enteric, 5), and Klebsiella pneumoniae was the only organism shared between intraoperative and postoperative cultures in two patients. The mean cost of transfusion products per patient intraoperatively was $990.95. Conclusion: The intraoperative use of the Cell Saver was microbiologically safe for liver transplantation. A significant proportion of salvaged blood samples exhibited bacterial contamination, primarily with nonenteric flora; however, this was not associated with an increased risk of post-transplant bacteremia. Enteric contamination was rare but clinically relevant in two cases, supporting continued use of ABT with caution in patients at risk of intraabdominal contamination. Furthermore, ABT might have contributed to lower transfusion costs compared with previously reported data. (c) 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).