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Xu J, Bai J, Pan H, Zhou Z. Impact of perioperative blood transfusion on prognosis after nephrectomy in patients with renal cell carcinoma: A meta-analysis and systematic review. Medicine (Baltimore) 2024; 103:e37646. [PMID: 38579099 PMCID: PMC10994588 DOI: 10.1097/md.0000000000037646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Perioperative blood transfusion (PBT) has been associated with worse prognosis in several malignancies. For renal cell carcinoma (RCC), the effect of PBT is still debated. OBJECTIVE To evaluate the impact of PBT on prognosis after nephrectomy in patients with RCC. METHODS This study is A systematic review and meta-analysis of published article data (PRISMA protocol) for literature related to PBT and RCC through extensive search of EMBASE, Medline via PubMed, Web of Science and Cochrane Library, language limited to English, with no time constraint until May 20, 2022. We pooled the results of multivariable cox regression analyses from each study, with subgroup analyses by dose and timing of transfusion. All analyses were done using Stata14. RESULTS A total of 12 studies involving 27,683 participants were included. Our meta-analysis pooled the results of multivariable cox regression analysis in each study, showing that PBT is associated with higher overall Mortality (OM; hazard ratio [HR] = 1.34, 1.23-1.44), cancer-specific mortality (CSM; HR = 1.35, 1.20-1.51), and disease recurrence (HR = 1.54, 1.18-1.89). when only patients with nonmetastatic RCC were included, PBT was still associated with higher OM (HR = 1.29, 1.11-1.47) and disease recurrence (HR = 1.58, 1.18-1.98), but the association with CSM (HR = 1.26, 0.99-1.52) was not statistically significant. In subgroup analysis by transfusion dose, small (1-2) units of PBT were not associated with CSM (HR = 1.84, 0.95-2.73), but large (≥3) units were associated with higher CSM (HR = 2.98, 1.74-4.22) and disease recurrence (HR = 1.99, 1.31-2.67). Each additional unit of PBT resulted in a higher CSM (HR = 1.07, 1.04-1.10). In subgroup analysis by transfusion timing, intraoperative transfusion was associated with higher CSM and disease recurrence, but postoperative transfusion was not. CONCLUSIONS PBT is associated with higher OM, CSM and disease recurrence. This adverse effect seems to be particularly significant in high-dose intraoperative transfusion. It is necessary to limit the overuse of PBT, especially high-dose intraoperative transfusion, in order to improve the prognosis of patients undergoing nephrectomy for RCC.
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Affiliation(s)
- Jiangnan Xu
- Department of Urology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, Yancheng, China
| | - Jinming Bai
- Department of Urology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, Yancheng, China
| | - Huixing Pan
- Department of Urology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, Yancheng, China
| | - Zhengdong Zhou
- Department of Urology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, Yancheng, China
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Mallick S, Mallik M, Chowdhury PS. Prognostic Implication and Survival Outcomes of Perioperative Blood Transfusion on Urological Malignancies Undergoing Radical Surgical Intervention. IRANIAN JOURNAL OF PATHOLOGY 2023; 18:33-48. [PMID: 37383156 PMCID: PMC10293603 DOI: 10.30699/ijp.2023.553040.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/24/2022] [Indexed: 06/30/2023]
Abstract
Background & Objective Background and objective: Perioperative blood transfusion (PBT) during radical urological surgeries has been associated with an increased incidence of complications. The present study analyzes the outcome of perioperative blood transfusion (PBT) and the prognostic implications after radical surgeries on patients with malignant urological tumors. Methods Our retrospective study included 792 cases of partial or radical nephrectomy /cystectomy/prostatectomy surgeries for kidney/bladder/ prostate carcinoma from 2012 to 2022. Data on preoperative, intraoperative, and pathological parameters were evaluated. PBT was taken as a period of transfusion of allogenic RBC during/preoperative/postoperative surgeries. The effect of PBT on oncological parameters like recurrence-free survival (RFS), overall survival (OS), and cancer-free survival (CSS) was compared using univariate cox regression analysis (Odds ratio, Hazard ratio). Results PBT was applied on 124 (20.6%) patients of nephrectomy, 54 (46.5%) patients of cystectomy, and 23 (31%) patients of prostatectomy. The baseline characteristics of the cohort study found symptomatic patients with older age and other co-morbidities to be transfusion-dependent. Also, the patients undergoing radical operations with more blood loss and advanced tumor stage were more likely to receive PBT. PBT was significantly associated with survival outcomes (P<0.05) in nephrectomy and cystectomy cases but independent of association in prostatectomy cases. Conclusion The result of this study concludes that in nephrectomy and cystectomy operations, PBT had a significant association with cancer recurrence and mortality; however, in prostatectomy cases, no significant correlation was noted. Thus, proper criteria to prevent the unnecessary use of PBT and more defined parameters for transfusion are needed to improve postoperative survival. Autologous transfusion should be considered more frequently. However, more extensive studies and randomized trials are needed in this area.
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Affiliation(s)
- Sujata Mallick
- Department of Pathology, KPC Medical College, West Bengal University of Health Science, Kolkata, India
| | - Mahasweta Mallik
- Department of Pathology, NSMCH, Bihta, Aryabhatta University, Patna, India
| | - Puskar Shyam Chowdhury
- Department of Urology, KPC Medical College, Professor, West Bengal University of Health Science, Kolkata, India
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Liu Y, Deng X, Wen Z, Huang J, Wang C, Chen C, Yang X. The effect of perioperative blood transfusion on survival after renal cell carcinoma nephrectomy: A systematic review and meta-analysis. Front Oncol 2023; 13:1092734. [PMID: 36874080 PMCID: PMC9978807 DOI: 10.3389/fonc.2023.1092734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Background The effect of perioperative blood transfusion (PBT) on postoperative survival in RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) remains controversial. Two meta-analyses in 2018 and 2019 reported the postoperative mortality of PBT patients with RCC, but they did not investigate the effect on the survival of patients. We performed a systematic review and meta-analysis of relevant literature to demonstrate whether PBT affected postoperative survival in RCC patients who received nephrectomy. Methods Pubmed, Web of Science, Cochrane, and Embase databases were searched. Studies comparing RCC patients with or without PBT following either RN or PN were included in this analysis. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included literature, and hazard ratios (HRs) of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), as well as 95% confidence intervals, were considered as effect sizes. All data were processed using Stata 15.1. Results Ten retrospective studies involving 19,240 patients were included in this analysis, with the publication dates ranging from 2014 to 2022. Evidence revealed that PBT was significantly associated with the decline of OS (HR, 2.62; 95%CI: 1,98-3.46), RFS (HR, 2.55; 95%CI: 1.74-3.75), and CSS (HR, 3.15; 95%CI: 2.3-4.31) values. There was high heterogeneity among the study results due to the retrospective nature and the low quality of the included studies. Subgroup analysis findings suggested that the heterogeneity of this study might be caused by different tumor stages in the included articles. Evidence implied that PBT had no significant influence on RFS and CSS with or without robotic assistance, but it was still linked to worse OS (combined HR; 2.54 95% CI: 1.18, 5.47). Furthermore, the subgroup analysis with intraoperative blood loss lower than 800 ML revealed that PBT had no substantial impact on OS and CSS of postoperative RCC patients, whereas it was correlated with poor RFS (1.42, 95% CI: 1.02-1.97). Conclusions RCC patients undergoing PBT after nephrectomy had poorer survival. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363106.
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Affiliation(s)
- Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xianzhong Deng
- Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China
| | - Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chongjian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Caixia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xuesong Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Sutton TL, Pasko J, Kelly G, Maynard E, Connelly C, Orloff S, Enestvedt CK. Intraoperative autologous transfusion and oncologic outcomes in liver transplantation for hepatocellular carcinoma: a propensity matched analysis. HPB (Oxford) 2022; 24:379-385. [PMID: 34294524 DOI: 10.1016/j.hpb.2021.06.433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative autologous transfusion (IAT) of salvaged blood is a common method of resuscitation during liver transplantation (LT), however concern for recurrence in recipients with hepatocellular carcinoma (HCC) has limited widespread adoption. METHODS A review of patients undergoing LT for HCC between 2008 and 2018 was performed. Clinicopathologic and intraoperative characteristics associated with inferior recurrence-free (RFS) and overall survival (OS) were identified using Kaplan-Meier analysis and uni-/multi-variable Cox proportional hazards modeling. Propensity matching was utilized to derive clinicopathologically similar groups for subgroup analysis. RESULTS One-hundred-eighty-six patients were identified with a median follow up of 65 months. Transplant recipients receiving IAT (n = 131, 70%) also had higher allogenic transfusions (median 5 versus 0 units, P < 0.001). There were 14 recurrences and 46 deaths, yielding an estimated 10-year RFS and OS of 89% and 67%, respectively. IAT was not associated with RFS (HR 0.89/liter, P = 0.60), or OS (HR 0.98/liter, P = 0.83) pre-matching, or with RFS (HR 0.97/liter, P = 0.92) or OS (HR 1.04/liter, P = 0.77) in the matched cohort (n = 49 per group). CONCLUSION IAT during LT for HCC is not associated with adverse oncologic outcomes. Use of IAT should be encouraged to minimize the volume of allogenic transfusion in patients undergoing LT for HCC.
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Affiliation(s)
- Thomas L Sutton
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of General Surgery, Portland, OR, 97239, USA
| | - Jennifer Pasko
- Providence Sacred Heart Medical Center, Liver and Pancreas Surgery, Spokane, WA, 99204, USA
| | | | - Erin Maynard
- OHSU Department of Surgery, Division of Abdominal Organ Transplant and Hepatobiliary Surgery, Portland, OR, 97239, USA
| | - Christopher Connelly
- OHSU Department of Surgery, Division of Abdominal Organ Transplant and Hepatobiliary Surgery, Portland, OR, 97239, USA
| | - Susan Orloff
- OHSU Department of Surgery, Division of Abdominal Organ Transplant and Hepatobiliary Surgery, Portland, OR, 97239, USA
| | - C Kristian Enestvedt
- OHSU Department of Surgery, Division of Abdominal Organ Transplant and Hepatobiliary Surgery, Portland, OR, 97239, USA.
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Hamilton ZA, Carbonella J, Siddiqui S, Al-Hammadi N, Hinyard L. Infectious complications associated with perioperative blood transfusion in partial or radical nephrectomy. Urol Oncol 2020; 39:134.e17-134.e26. [PMID: 33250344 DOI: 10.1016/j.urolonc.2020.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION/BACKGROUND Perioperative allogeneic blood transfusion (PBT) is associated with increased infectious risk for many surgical procedures, although this has not been thoroughly explored for extirpative renal surgery. Underlying mechanisms may be related to an alteration of the patient immune response. We aimed to assess the infectious complications associated with PBT after radical or partial nephrectomy. METHODS/MATERIALS The Nationwide Inpatient Sample (1996-2015) was queried for patients undergoing radical or partial nephrectomy. We assessed rates of infectious complications in patients who did and did not receive PBT. Infections were index complications and included sepsis, abscess, pneumonia, urinary tract infection, and wound infection. Multivariable logistic regression was used to examine the risk of infectious complications accounting for age, gender, race, insurance, income, surgery type and approach, length of stay, comorbidity, and PBT. RESULTS We identified 140,183 patients undergoing partial or radical nephrectomy during the study period with 17,874 (12.7%) receiving PBT. The rate of PBT was stable throughout the study period (Cochran-Armitage, P= 0.97). Patients receiving PBT compared to those without were relatively older (proportion of age >70, 42.6% vs. 30.5%), non-white (25.4% vs. 21.1%), who underwent radical nephrectomy (84.3% vs. 77.4%), and with longer hospital stay (9.1 vs. 5.1 days; all P< 0.001). On multivariable analysis, PBT was associated with higher odds of any infectious complication (OR 1.56, 95% CI 1.5-1.68, P< 0.001). During the study period, the risk of infectious complications was persistently increased in those receiving PBT. CONCLUSION PBT is independently associated with an increased risk of postoperative infections for patients undergoing partial or radical nephrectomy. This may be due to underlying transfusion-related immunomodulatory mechanisms. While PBT is necessary in many instances to promote patient survival, providers should remain cautious when providing PBT after extirpative renal surgery.
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Affiliation(s)
- Zachary A Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
| | | | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO
| | - Noor Al-Hammadi
- Advanced Health Data Institute, Department of Health and Clinical Outcomes Research, St Louis, MO
| | - Leslie Hinyard
- Advanced Health Data Institute, Department of Health and Clinical Outcomes Research, St Louis, MO
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Wissenschaftliche Erläuterungen zur Stellungnahme Transfusionsassoziierte Immunmodulation (TRIM) des Arbeitskreises Blut vom 13. Februar 2020. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1025-1053. [PMID: 32719887 PMCID: PMC7384277 DOI: 10.1007/s00103-020-03183-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kang HW, Seo SP, Kim WT, Yun SJ, Lee SC, Kim WJ, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kim HH, Kwak C, Byun SS, Kim YJ. Intraoperative allogeneic blood transfusion is associated with adverse oncological outcomes in patients with surgically treated non-metastatic clear cell renal cell carcinoma. Int J Clin Oncol 2020; 25:1551-1561. [PMID: 32504136 DOI: 10.1007/s10147-020-01694-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/29/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The objective of this study was to provide more definitive information about the prognostic impact of perioperative blood transfusion (PBT) on patients with surgically treated renal cell carcinoma (RCC). METHODS A database of 4019 patients with clear cell RCC, all of whom underwent radical or partial nephrectomy as primary therapy as part of a multi-institutional Korean collaboration between 1988 and 2015, was analyzed retrospectively. PBT was defined as transfusion of allogeneic red blood cells during surgery or postsurgical period. Receipt of a PBT, as well as the amount and time of blood transfusion (BT), was compared. RESULTS Overall, 335 (8.3%) patients received a PBT: 84 received postoperative BT, 202 received intraoperative BT, and 49 received both intraoperative and postoperative BT. Patients receiving a PBT had a poor preoperative immuno-nutritional status, and aggressive tumor characteristics. Multivariate analyses identified PBT as an independent predictor of recurrence-free survival and cancer-specific survival. Prognostic impact of PBT was restricted to those with locally advanced stage (pT3-4), and who underwent radical nephrectomy. Among patients who received a PBT, intraoperative (but not postoperative) BT was a prognostic factor for survival. Among patients who received intraoperative BT, those receiving three or more transfusion units had a significantly worse survival. CONCLUSION Receipt of a PBT was an independent predictor of RFS and CSS in patients with surgically treated RCC, specifically locally advanced disease. Regarding the prognostic impact of timing or dose of PBT on survival, intraoperative BT and ≥ 3 pRBC units were associated with adverse oncological outcomes.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sung Pil Seo
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sang-Cheol Lee
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, South Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, South Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Kyunggi-do, 463-707, South Korea.
| | - Yong-June Kim
- Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea. .,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea.
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Seon DY, Kwak C, Kim HH, Ku JH, Kim HS. Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort. Investig Clin Urol 2020; 61:136-145. [PMID: 32158964 PMCID: PMC7052423 DOI: 10.4111/icu.2020.61.2.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Results PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan–Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008–1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033–1.100; p<0.001). Conclusions The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.
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Affiliation(s)
- Dong Young Seon
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
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Takekawa D, Saito J, Kinoshita H, Hashiba EI, Hirai N, Yamazaki Y, Kushikata T, Hirota K. Acute normovolemic hemodilution reduced allogeneic blood transfusion without increasing perioperative complications in patients undergoing free-flap reconstruction of the head and neck. J Anesth 2019; 34:187-194. [PMID: 31768720 PMCID: PMC7223952 DOI: 10.1007/s00540-019-02714-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/14/2019] [Indexed: 01/25/2023]
Abstract
Purpose The present case–control study was conducted to evaluate whether acute normovolemic hemodilution (ANH) can reduce the need for perioperative allogeneic blood transfusion (ABT) and affect the incidence of perioperative complications in free-flap reconstruction of the head and neck. Methods This single-center, retrospective, observational study included the perioperative data of 123 patients who underwent free-flap reconstruction of the head and neck following oncological surgery. Patients were divided into the following two groups according to whether they received ANH: ANH group and non-ANH group. We investigated whether ANH can reduce the need for perioperative ABT using propensity score-adjusted logistic regression analysis. Results Of the 123 patients, 113 patients were assessed; 57 patients were in the ANH group and 56 patients were in the non-ANH group. The rate [ANH group vs. non-ANH group, n (%): 2 (3.5%) vs. 23 (41.1%), p < 0.0001] and amount [median (IQR): 0 mL (0, 0) vs. 0 mL (0, 280), p < 0.0001] of ABT were significantly lower in the ANH group than in the non-ANH group. Propensity score-adjusted multivariate logistic regression analysis indicated that ANH use [odds ratio (OR): 0.040; 95% confidence interval (CI) 0.005, 0.320; p = 0.0024)] was one of the independent predictors of perioperative ABT. There were no significant differences in the incidences of post-operative complications between the two groups. Conclusion ANH use can reduce the need for perioperative ABT in patients undergoing free-flap reconstruction of the head and neck without increasing the incidence of post-operative complications.
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Affiliation(s)
- Daiki Takekawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Hirotaka Kinoshita
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Eij I Hashiba
- Division of Intensive Care Unit, Hiroski University Hospital, Hirosaki, Japan
| | - Naoki Hirai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Yuma Yamazaki
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Tetsuya Kushikata
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
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Marszalek M. Risk reduction in kidney surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S89. [PMID: 31576297 DOI: 10.21037/atm.2019.04.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
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