The Effect of Allogenic Blood Transfusion on Oncologic Outcomes in Locally Advanced Kidney Cancer

Renal cell carcinoma (RCC) is the most common renal malignancy and the ninth most prevalent cancer in the United States. Given high vascularity of RCC, locally advanced tumors have elevated risks of blood loss during surgery and frequently require allogenic perioperative blood transfusion (PBT). PBT has been associated with adverse effects on mortality and morbidity in patients undergoing benign and malignant surgeries.

This is a retrospective review of patients undergoing open or minimally invasive radical nephrectomy with final pathology of T stage ≥ T2b RCC at three large academic referral centers. PBT was defined as the transfusion of allogenic red blood cells either during the operation or during the index hospitalization. Multivariable hazard models were used to investigate the effect of PBT on the overall survival and recurrence-free survival, controlling for clinicopathologic variables.

Of the 633 total patients included in the study, 125 (20%) received PBT. Among patients who underwent PBT, 57 (46%) had recurrence, with 65 (52%) surviving, while only 111 (22%) of the 508 patients without PBT had recurrence and 421 (83%) survived. PBT is associated with decreased overall survival (HR, 1.90 [1.25, 2.90]) and increased recurrence (sHR 2.19 [1.44, 3.34]).

To our knowledge, this is the first multi-institutional cohort study with a focus on locally advanced RCC. Our analysis suggests perioperative blood transfusion is associated with decreased recurrence-free survival and overall survival in patients with RCC, suggesting surgeons performing complex kidney surgery should safely try to avoid allogenic transfusion to potentially improve outcomes. While these findings serve as essential groundwork, the association between PBT and survival requires further validation in prospective randomized trials to establish definitive transfusion thresholds and mitigate the inherent selection bias of retrospective data.