The impact of perioperative blood transfusion on survival after nephrectomy for non-metastatic renal cell carcinoma (RCC).
OBJECTIVE
To evaluate the association of perioperative blood transfusion (PBT) with survival after nephrectomy.


METHODS
We identified 2318 patients who underwent partial or radical nephrectomy at Mayo Clinic between 1990 and 2006. PBT was defined as transfusion of allogenic red blood cells during surgery or postoperative hospitalisation. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to evaluate the association of PBT with outcome.


RESULTS
In all, 498 patients (21%) received a PBT. The median (interquartile range) number of units transfused was 3 (2, 5). Patients receiving a PBT were significantly older at surgery (P < 0.001), more likely to be female (P < 0.001), with more frequent symptomatic presentation (P < 0.001), worse Eastern Cooperative Oncology Group performance status (P < 0.001), and more frequent adverse pathological features, such as high nuclear grade (P < 0.001), locally-advanced tumour stage (P < 0.001) and lymph node invasion (P < 0.001). The median follow-up was 9.1 years. Receipt of a PBT was associated with adverse 5-year cancer-specific (68% vs 92%; P < 0.001) and overall (56% vs 82%; P < 0.001) survival. On multivariate analyses, PBT remained associated with higher risk of death from any cause (hazard ratio [HR] 1.23; P = 0.02). Among patients who received a PBT, an increasing number of units transfused was independently associated with increased all-cause mortality (HR 1.08; P = 0.001).


CONCLUSIONS
PBT is associated with a significantly increased risk of mortality after nephrectomy. While external validation is needed, continued efforts to minimise the use of blood products in these patients are warranted.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Brian J
BJ
Linder
R Houston
RH
Thompson
Bradley C
BC
Leibovich
John C
JC
Cheville
Christine M
CM
Lohse
Dennis A
DA
Gastineau
Stephen A
SA
Boorjian
D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000401:mortality; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D019990:Perioperative Care / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
kidney cancer; outcomes; renal cell carcinoma (RCC); transfusion