AUA 2017: Restrictive transfusion in radical cystectomy is safe

Boston, MA ( Moffat et al and Linder et al have shown the benefit of restricted perioperative transfusion after radical cystectomy. Some of the proposed mechanisms of action include immunomodulation vs. increased comorbidity in patients who received perioperative transfusion. The authors evaluated patients who were subjected to restricted perioperative transfusion protocols vs. those in whom transfusion was not limited. Restricted perioperative transfusion protocols include using postoperative hemoglobin thresholds of 7 g/dL and 8 g/dL for those over the age of 75 or with cardiopulmonary comorbidities. After pairwise matching, 87 pairs of limited and non-limited patients were identified, with similar clinicopathologic features. In the restrictive group, 32% received perioperative transfusion, whereas over 90% of the patients in the non-restricted group were transfused. No difference was found in the incidence of perioperative complications, re-admission rates or 90-day all-cause mortality. Consistent with previous findings, patients who received transfusion had higher Charlson comorbidity scores, higher disease stage, and more likely to have received neoadjuvant chemotherapy. The authors furthermore evaluated the predictors of transfusion, and found age, high CCMI, NAC use, and pathologic T3 disease or higher predicted for transfusion. Interestingly, EBL was not a significant predictor of transfusion. Finally, patients receiving perioperative transfusion were at 2-fold increased risk for cancer recurrence and overall death. Taken together, restricted transfusion protocols are safe, and lead to improved survival.

While the improved survival was shown to be associated with better survival outcomes, the mechanism for this improvement remains elusive. It is likely that the receipt of perioperative transfusion can be associated with higher comorbidities or worse disease status, leading to decreased RFS and OS. However, if proven true, reversing the immunomodulation due to perioperative transfusion may lead to improved outcomes.

Presented by: Sumeet Syan-Bhanvadia, MD, USC

Written by: Roger Li MD Urologic Oncology Fellow, UT MD Anderson Cancer Center
Ashish M. Kamat MD Wayne B. Duddlesten Professor, UT MD Anderson Cancer Center

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA