The impact of intraoperative blood salvage (IBS) on tumor recurrence, disease-free survival, and overall survival in patients receiving liver transplantation was evaluated to determine if IBS was safe. IBS was very impactful in the reduction of the utilization of allogeneic blood transfusion. The fear of disseminating malignant cells is the reason behind the questioning of IBS’s safety while liver transplantation for patients with hepatocellular carcinoma (HCC). In 8 databases, full-scale searches were processed through June 21. The methodological quality of the involved research was related to using the Robins-I tool. The generic inverse variance method was performed with meta-analysis to evaluate pooled hazard ratios (HRs) for disease-free survival, HCC recurrence, and overall survival. Furthermore, 9 researches were included (n=1,997, IBS n=1,200, no-IBS n=797). Use of IBS during liver transplantation was not associated with impaired disease-free survival [HR=0.90, 95% CI=0.66–1.24, P=0.53, IBS n=394, no-IBS n=329], not associated with increased HCC recurrence (HR=0.83, 95% CI=0.57–1.23, P=0.36, IBS n=537, no-IBS n=382) and not associated with impaired overall survival (HR=1.04, 95% CI=0.79–1.37, P=0.76, IBS n=495, no-IBS n=356). Utilization of IBS during liver transplantation in patients with HCC did not turn out to impaired disease-free survival, increased HCC recurrence, or impaired overall survival, in accordance with the obtained information. Therefore, the use of IBS during liver transplantation for HCC patients was a safe method.

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