title: Perioperative Allogenic Blood Transfusion in Renal Cell Carcinoma: Risk Factors and Effect on Long-term Outcomes.
abstract: We sought to create a preoperative model to predict the risk of perioperative blood transfusion (PBT) in patients with renal cell carcinoma (RCC) undergoing nephrectomy and to evaluate the effect of PBT on long-term outcomes.
  
  
  
  The present retrospective study included 648 consecutive patients who had undergone radical or partial nephrectomy for RCC at a single institution. The risk factors for PBT were analyzed using logistic regression analysis. Cox proportional hazards models addressed the effect of PBT on overall and RCC-specific mortality.
  
  
  
  A total of 62 patients (10%) received a median of 2 red blood cell units (interquartile range, 2-3; range 1-20). On multivariable logistic regression analysis, 2 preoperative factors were independently associated with receipt of PBT: preoperative anemia (odds ratio, 6.28; P < .001) and open surgery (odds ratio, 3.40; P < .001). The risk of receiving PBT was high with both risk factors present (34%), intermediate with 1 risk factor present (7%-12%), and low with 0 risk factors present (2%). Within a median follow-up period of 63 months (interquartile range, 32-91), 108 patients (17%) had died of RCC and 177 (27%) had died of any cause. In the multivariable Cox models, PBT remained independently associated with overall mortality (hazard ratio [HR], 1.86; P = .004) and RCC-specific mortality (HR, 1.79; P = .007). A dose-dependent association of PBT with RCC-specific mortality was observed (HR, 1.14; P = .01).
  
  
  
  In patients undergoing surgery for RCC, PBT was associated with adverse overall and RCC-specific mortality. Patients with preoperative anemia and those scheduled to undergo open surgery are at an increased risk of PBT and could be candidates for perioperative optimization techniques.
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Soria
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Michela
authors.initials: M
authors.lastname: de Martino
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Carmen V
authors.initials: CV
authors.lastname: Leitner
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: tobias.klatte@meduniwien.ac.at.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D000368:Aged; D000740:Anemia / Q000401:mortality / Q000628:therapy*; D001803:Blood Transfusion / Q000401:mortality*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D059035:Perioperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Perioperative blood transfusion; Preoperative model; Prognosis; Renal carcinoma; Survival