Perioperative Blood Transfusions Hike RCC Patient Mortality

Researchers find a 23% increased risk of death for transfusion during surgery.
Researchers find a 23% increased risk of death for transfusion during surgery.

Perioperative blood transfusion (PBT) is associated with an increased risk of death among patients who undergo surgery for non-metastatic renal cell carcinoma (RCC), according to a new study.

A team at Mayo Clinic in Rochester, Minn., led by Stephen A. Boorjian, MD, studied 2,318 patients who underwent partial or radical nephrectomy for non-metastatic RCC. They defined PBT as a transfusion of allogenic red blood cells during surgery or post-operative hospitalization. Of the 2,318 patients, 498 (21%) received a PBT. The median number of units transfused was 3.

The median follow-up was 9.1 years. Five-year cancer-specific and overall survival rates were significantly lower for patients who received a PBT (68% vs. 92% and 56% vs. 82%, respectively), Dr. Boorjian's group reported online ahead of print in BJU International. On multivariate analysis, receipt of PBT was associated with a significant 23% increased risk of death, but the association between receipt of PBT and death from RCC and tumor recurrence did not reach statistical significance.

In addition, the study found that the risk of all-cause mortality increased along with the number of units transfused. Each unit transfused was associated with an 8% increased risk of death.

“While these results represent outcomes from a single tertiary care centre, and external validation is needed, continued efforts to limit the use of blood products in these patients are needed,” the authors concluded.

The researchers also found that patients who received a PBT were significantly older at the time of surgery and significantly more likely to be female. They also were more likely to have symptomatic presentation and adverse pathologic features.

The authors cited previous studies showing that nephrectomy is associated with a PBT rate ranging from 2.5%-18.1%.

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