Faculty Collaboration Database

Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection. Pediatr Blood Cancer 2025 Dec;72(12):e32029

Date

09/03/2025

Pubmed ID

40899404

DOI

10.1002/pbc.32029

Scopus ID

2-s2.0-105015172126 (requires institutional sign-in at Scopus site)

Abstract

INTRODUCTION: Children with hepatoblastoma (HB) and other solid tumors frequently undergo intraoperative blood transfusion (IBT) with unknown impact on oncologic outcomes and scant data to guide transfusion in this population. This study tested the hypothesis that IBT is associated with poorer survival in children with HB.

METHODS: A multicenter retrospective observational study of patients aged <18 years with HB who underwent primary tumor resection, including liver transplantation, from 2010 to 2019 was performed at 19 institutions. The association of IBT with risk of recurrence and death were determined using propensity score reweighted (PSR) Cox proportional hazards regression analyses.

RESULTS: There were 338 patients identified who met inclusion criteria and had sufficient data for inclusion. Of those, 257 (76%) received IBT, including 253 (98%) who received packed red blood cells (pRBC), 84 (33%) who received plasma, and 28 (11%) who received platelets. IBT was associated with higher pretreatment extent of disease (p < 0.001), presence of annotation factors (+VPEFR: 50%, n = 129 vs. 37%, n = 30, p = 0.035), and complex resections (extended, meso-, or total hepatectomy: 54%, n = 139 vs. 27%, n = 22, p < 0.001); these differences were mitigated after applying propensity score weighting. Patients who received IBT had greater postoperative hemoglobin (g/dL) (median 10 (I8-11) vs. 9 (8-10), p = 0.013) and required more postoperative plasma and platelet transfusions (p < 0.05). Median follow-up was 4.4 (2.0-8.3) years. Compared with non-IBT patients, those with IBT had higher incidence of death (PSR HR 2.35, 95% CI 1.10-5.02). Recurrence did not significantly differ across groups (PSR HR = 0.82, 95% CI 0.45-1.48).

CONCLUSION: IBT was associated with greater hazard of death. Postoperative hemoglobin levels suggested that unnecessary transfusions occurred and a pRBC-focused approach to IBT led to coagulopathy. Development of optimal transfusion strategies for HB are needed to minimize unnecessary transfusions.

Author List

Polites SF, Aldrink JH, Lautz TB, Vierkant RA, Ragan MV, Reiter A, Chen SY, Kim ES, Rinehardt HN, Malek MM, Fleming AM, Murphy AJ, Roach JP, Radhakrishnan S, Kastenberg ZJ, Piche N, Osman Y, Iii HNL, Tracy ET, Favela J, Le HD, Marquart J, Craig B, Lal DR, Seemann N, Petroze R, Rich BS, Glick RD, Selesner L, Yoo A, Fialkowski E, Brown EG, Boehmer C, Dasgupta R, Langham MR Jr

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Blood Transfusion
Child
Child, Preschool
Female
Follow-Up Studies
Hepatectomy
Hepatoblastoma
Humans
Infant
Intraoperative Care
Liver Neoplasms
Male
Neoplasm Recurrence, Local
Prognosis
Retrospective Studies
Survival Rate