Characteristics of Transfusion & Association w/ Oncologic Outcomes in Hepatoblastoma Resection

Infographic · Mar 2026 · 2 min read

In brief

Multicenter study of 338 pediatric hepatoblastoma patients found that intraoperative blood transfusion was associated with 2.35-fold increased mortality risk but no difference in recurrence. Evidence of unnecessary transfusions and pRBC-focused protocols causing coagulopathy suggests need for optimized transfusion strategies in this population.

76% of pediatric hepatoblastoma resections involved intraoperative transfusion, primarily packed RBCs, associated with 2.35x higher mortality risk.
Intraoperative blood transfusion correlated with higher postoperative hemoglobin (median 10 vs 9 g/dL), suggesting unnecessary transfusions occurred.
pRBC-focused transfusion approach led to coagulopathy requiring additional postoperative plasma and platelet transfusions.
IBT did not significantly affect recurrence rates (HR 0.82), but was linked to more complex resections and advanced pretreatment disease.
Optimal transfusion protocols for hepatoblastoma surgery are needed to minimize unnecessary blood product administration and improve survival.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, accompanied by bullet-pointed text describing outcomes. The layout uses a clean, educational design with consistent formatting across columns.

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

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.

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