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

Infographic · Mar 2026 · 2 min read

In brief

This multicenter study of 338 pediatric hepatoblastoma patients found that intraoperative blood transfusion was associated with increased mortality risk but not recurrence. The findings suggest current transfusion practices may be excessive and contribute to coagulopathy, highlighting the need for evidence-based transfusion protocols in pediatric liver tumor surgery.

76% of pediatric hepatoblastoma resections involved intraoperative blood transfusion, associated with 2.35× higher mortality risk.
Postoperative hemoglobin levels suggested unnecessary transfusions occurred; pRBC-focused approach led to coagulopathy requiring plasma/platelets.
Intraoperative transfusion did not increase recurrence risk (HR 0.82), suggesting mortality association may relate to transfusion practice patterns.
Complex resections (extended/total hepatectomy) and advanced disease (+VPEFR annotation) strongly predicted need for intraoperative transfusion.
Restrictive transfusion protocols and balanced blood product strategies needed to reduce unnecessary transfusions in pediatric hepatoblastoma surgery.

Written by the GCMD Library team from the infographic.

The infographic uses a teal, purple, and coral color scheme with illustrated graphics including a clock icon, liver diagram, surgical team, nurse with IV pole, and blood vials. Content is organized in distinct sections with bullet points and text boxes highlighting key findings from a multicenter study.

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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