P5802 - The Safety and Efficacy of Hypovolemic Phlebotomy on Blood Loss and Transfusion in Liver Surgery: A Meta-Analysis of Randomized Controlled Trials

Aruba Sohail, MBBS¹, Usama Butt, MBBS², Tarannum Bano, MBBS³, Ayeeza Asghar, MBBS⁴, Israr Ul Haq, MBBS⁵, Muhammad Shoaib, MBBS⁶, Muhammad Saud Iqbal, MBBS⁷, Muhammad Ayyan, MBBS⁸, Muhammad Hassan Nawaz, MBBS², Faria Riaz, MBBS⁹, Xain Tauqeer, MBBS¹⁰, Sajjad Ali, MBBS², Huzaifa Ahmad Cheema, MBBS⁸, Ambreen Nabeel, MBBS¹¹, Rehmat Ullah Awan, MD¹¹, Khalid Mumtaz, MBBS, MSc¹²
1Dow Medical College, Karachi, Sindh, Pakistan; 2Allama Iqbal Medical College, Department of Medicine, Pakistan, Lahore, Punjab, Pakistan; 3Brijesh Multispecialty Hospital, India, Nainital, Uttarakhand, India; 4CMH Lahore Medical College and Institute of Dentistry, Department of Medicine, Pakistan, Lahore, Punjab, Pakistan; 5Doctors Hospital & Medical Center, Pakistan, Lahore, Punjab, Pakistan; 6Khyber teaching hospital, Pakistan, Peshawar, North-West Frontier, Pakistan; 7Department of Surgery, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan; 8King Edward Medical University, Lahore, Punjab, Pakistan; 9King Edward Medical University, Department of Medicine, Pakistan, Lahore, Punjab, Pakistan; 10Rashid Latif Medical College, Department of Medicine, Pakistan, Lahore, Punjab, Pakistan; 11West Virginia University, Morgantown, WV; 12The Ohio State University Wexner Medical Center, Columbus, OH

Introduction: Effective strategies to minimize blood loss and transfusion during liver resection are limited by weak clinical evidence. Hypovolemic phlebotomy, a technique involving controlled venous drainage to reduce hepatic venous pressure, is a promising technique, but prior randomized trials were small and underpowered. The recent PRICE-2 trial provides robust data, to strengthen the evidence of this intervention. We conducted this meta-analysis to provide a comprehensive update on the efficacy and safety of hypovolemic phlebotomy in liver surgery, aiming to clarify its clinical utility.

Methods: A PRISMA-guided meta-analysis was conducted using randomized trials comparing hypovolemic phlebotomy to standard of care in liver surgery. MEDLINE, Embase, and Cochrane databases were searched. Primary outcomes was blood loss. Secondary outcomes were packed red blood cell (pRBC) transfusion, complications and mortality. The risk of bias in included studies was assessed using the revised Cochrane “Risk of Bias” tool for RCTs (RoB 2.0). Data was pooled using a random-effects model, with risk ratios (RR) as the effect measure for dichotomous outcomes and mean difference (MD) as the effect measure for continuous outcomes.

Results: Four randomized trials including 607 patients were included. Hypovolemic phlebotomy led to a significant reduction in intraoperative blood loss (MD −126.11 mL; 95% CI −225.42 to −26.8). Rates of pRBC transfusion (RR: 0.74; 95% CI: 0.22–2.45), major complications (RR: 0.98; 95% CI: 0.66–1.47), overall complications (RR: 0.88; 95% CI: 0.55–1.40), and mortality (RR: 2.00; 95% CI: 0.19–20.93) were similar between groups, with no statistically significant differences observed.

Discussion: Hypovolemic phlebotomy significantly reduces blood loss in liver surgery without increasing complications or mortality. While no clear effect on transfusion rates was observed, its safety and blood-sparing effect support its use as a valuable intraoperative strategy.


Figure: Table 1. Characteristics of Included Studies

Disclosures:
Aruba Sohail indicated no relevant financial relationships.
Usama Butt indicated no relevant financial relationships.
Tarannum Bano indicated no relevant financial relationships.
Ayeeza Asghar indicated no relevant financial relationships.
Israr Ul Haq indicated no relevant financial relationships.
Muhammad Shoaib indicated no relevant financial relationships.
Muhammad Saud Iqbal indicated no relevant financial relationships.
Muhammad Ayyan indicated no relevant financial relationships.
Muhammad Hassan Nawaz indicated no relevant financial relationships.
Faria Riaz indicated no relevant financial relationships.
Xain Tauqeer indicated no relevant financial relationships.
Sajjad Ali indicated no relevant financial relationships.
Huzaifa Ahmad Cheema indicated no relevant financial relationships.
Ambreen Nabeel indicated no relevant financial relationships.
Rehmat Ullah Awan indicated no relevant financial relationships.
Khalid Mumtaz indicated no relevant financial relationships.

Aruba Sohail, MBBS¹, Usama Butt, MBBS², Tarannum Bano, MBBS³, Ayeeza Asghar, MBBS⁴, Israr Ul Haq, MBBS⁵, Muhammad Shoaib, MBBS⁶, Muhammad Saud Iqbal, MBBS⁷, Muhammad Ayyan, MBBS⁸, Muhammad Hassan Nawaz, MBBS², Faria Riaz, MBBS⁹, Xain Tauqeer, MBBS¹⁰, Sajjad Ali, MBBS², Huzaifa Ahmad Cheema, MBBS⁸, Ambreen Nabeel, MBBS¹¹, Rehmat Ullah Awan, MD¹¹, Khalid Mumtaz, MBBS, MSc¹². P5802 - The Safety and Efficacy of Hypovolemic Phlebotomy on Blood Loss and Transfusion in Liver Surgery: A Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.