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Keywords:

  • renal cell carcinoma (RCC);
  • kidney cancer;
  • transfusion;
  • outcomes

Objective

  • To evaluate the association of perioperative blood transfusion (PBT) with survival after nephrectomy.

Patients and 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).

Conclusion

  • 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.