Blood transfusions can be lifesaving in pediatric patients with solid malignancies; however, the risks of transfusion are poorly understood in this population. In adult patients with lung, esophageal, or colon cancer, perioperative blood transfusions have been associated with poorer short and long term outcomes when compared to those who did not receive transfusions. Additionally, reduction of perioperative transfusions using restrictive transfusion practices and a blood management program was associated with decreased postoperative morbidity. Hypotheses for this finding include transfusion-associated pro-inflammatory state, immunosuppression, or transfusion as a surrogate for underlying anemia. In the pediatric population, perioperative transfusion has been associated with increased odds of short term morbidity following tumor resection. The independent association between perioperative transfusion and oncologic outcomes of pediatric solid tumor resection remains unknown. A recent NSQIP-pediatric study found that 60% of patients with hepatoblastoma and 30% of patients with Wilms tumor received a perioperative transfusion, highlighting the importance of understanding the implications of this intervention. This current retrospective study aims to identify associations between transfusion and oncologic outcomes while better characterizing perioperative transfusion in children with hepatoblastoma. This will inform future prospective studies with the goal of identifying transfusion criteria and optimizing the approach to transfusions in these children.
