# Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection — GCMD Library

<i>Stephanie F Polites, Jennifer H Aldrink, Timothy B Lautz, Robert A Vierkant, Mecklin V Ragan, Audra Reiter, Stephanie Y Chen, Eugene S Kim, Hannah N Rinehardt, Marcus M Malek, Andrew M Fleming, Andrew J Murphy, Jonathan P Roach, Sridharan Radhakrishnan, Zachary J Kastenberg, Nelson Piche, Yasmin Osman, Harold N Lovvorn III, Elisabeth T Tracy, Juan Favela, Hau D Le, John Marquart, Brian Craig, Dave R Lal, Natashia Seemann, Robin Petroze, Barrie S Rich, Richard D Glick, Leigh Selesner, Ashley Yoo, Elizabeth Fialkowski, Erin G Brown, Chloe Boehmer, Roshni Dasgupta, Max R Langham Jr</i><div><i><br></i></div><div><b>Introduction:</b> 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.</div><div><br></div><div><b>Methods:</b> 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.</div><div><br></div><div><b>Results:</b> 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).</div><div><br></div><div><b>Conclusion:</b> 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.</div>

Type: video · 1 min · posted 2026-04-10
Canonical: https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811

## Chapters
- [0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0) Introduction and Study Context
- [0:24](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=24) Study Findings
- [0:51](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=51) Author Recommendations

## Statements
- "It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection" — Jill Knepprath (clinical) [0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0)
- "The study was multi-institutional and published in Pediatric Blood and Cancer in 2025" — Jill Knepprath (epidemiological) [0:13](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=13)
- "The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients" — Jill Knepprath (epidemiological) [0:19](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=19)
- "Of those transfused, the majority received red blood cells" — Jill Knepprath (epidemiological) [0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Only 11% of transfused patients received platelets" — Jill Knepprath (epidemiological) [0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Intraoperative blood transfusions had no effect on recurrence" — Jill Knepprath (clinical) [0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "Intraoperative blood transfusions were associated with increased death" — Jill Knepprath (clinical) [0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "There were instances of unnecessary blood transfusions" — Jill Knepprath (clinical) [0:39](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=39)
- "Patients who were transfused had higher post-op hemoglobin" — Jill Knepprath (clinical) [0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "Transfused patients still required more plasma and platelets postoperatively" — Jill Knepprath (clinical) [0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy" — Jill Knepprath (opinion) [0:52](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=52)
- "The authors recommend more careful patient selection for intraoperative transfusions" — Jill Knepprath (guideline) [1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- "The authors recommend a balanced transfusion approach" — Jill Knepprath (guideline) [1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)

## Transcript
It's not uncommon for a patient with hepatoblastoma to need a transfusion during resection. But do we know if this affects oncologic outcomes? I'm Jill Kneroth with Staker and MD, and this is an article you should know. This was a multi-institutional study published in Pediatric Blood and Cancer in 2025. They looked at how intraoperative transfusion may affect recurrence and survival in these patients. So what did they find? Of those transfused, the majority of them received red blood cells, but only 11% received platelets. Intraoperative blood transfusions had no effect on recurrence, however, they were associated with increased death. Importantly, they found instances of unnecessary blood transfusions. Patients who were transfused had higher post-op hemoglobin, however, they still required more plasma and platelets postoperatively. What do the authors suggest? The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy. They recommend more careful patient selection for intraoperative transfusions and a balanced transfusion approach. Does this change the way you see intraoperative transfusions?

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Not medical advice · citation policy: https://library.globalcastmd.com/ai