Impact of Perioperative Allogenic Blood Transfusion on Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

The present retrospective multicenter study analyzed the effect of perioperative blood transfusions (PBTs) on the outcomes in 285 patients with upper tract urothelial carcinoma who had undergone radical nephroureterectomy (RNU). We found that patients receiving PBTs had inferior survival compared with that of patients without PBTs. Future investigations should focus on optimization of preoperative hemoglobin levels, surgical accuracy, and anesthetic management of RNU. Background: Preoperative anemia is an independent predictor for unfavorable outcomes in patients with upper tract urothelial carcinoma (UTUC) who undergo radical nephroureterectomy (RNU). The effect of perioperative blood transfusion (PBT) on survival, however, has been insufficiently investigated. We investigated the impact of PBT on the outcomes of patients UTUC treated with RNU. Patients and Methods: We analyzed the data from 285 patients with UTUC who had undergone RNU at 3 German academic institutions. PBT administration was analyzed as a dichotomous variable (administered vs. not administered) and the number of PBT units as a continuous and categorical variable (0 vs. 2). Cox regression models were used to analyze the impact of PBT on disease recurrence and survival. Results: A total of 81 patients (28.4%) had received a PBT with a median number of 2 U (interquartile range, 2-4). The administration of PBT was associated with advanced tumor stage, higher tumor grade, and preoperative anemia (P <= .049 for all). At a mean follow-up of 52 months, PBT and an increasing number of PBT units were significantly associated with inferior overall survival (P <= .025). On multivariable analyses adjusted for established UTUC outcome prognosticators, PBT was significantly associated with inferior overall survival (hazard ratio, 1.6; 95% confidence interval, 1.055-2.428; P = .027). Conclusion: PBT is an independent risk factor for worse overall survival in patients with UTUC treated with RNU. Continued efforts are warranted to optimize patients' preoperative hemoglobin level, surgical accuracy, and anesthetic management of RNU to reduce the necessity for PBTs. (C) 2016 Elsevier Inc. All rights reserved