{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T17:27:26Z","timestamp":1781890046675,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter retrospective observational study of patients aged &lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.001), presence of annotation factors (+VPEFR: 50%,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0129\u00a0vs. 37%,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a030,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.035), and complex resections (extended, meso\u2010, or total hepatectomy: 54%,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0139\u00a0vs. 27%,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a022,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001); these differences were mitigated after applying propensity score weighting. Patients who received IBT had greater postoperative hemoglobin (g\/dL) (median 10 (I8\u201311) vs. 9 (8\u201310),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.013) and required more postoperative plasma and platelet transfusions (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). Median follow\u2010up was 4.4 (2.0\u20138.3) years. Compared with non\u2010IBT patients, those with IBT had higher incidence of death (PSR HR 2.35, 95% CI 1.10\u20135.02). Recurrence did not significantly differ across groups (PSR HR = 0.82, 95% CI 0.45\u20131.48).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IBT was associated with greater hazard of death. Postoperative hemoglobin levels suggested that unnecessary transfusions occurred and a pRBC\u2010focused approach to IBT led to coagulopathy. Development of optimal transfusion strategies for HB are needed to minimize unnecessary transfusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32029","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T10:01:26Z","timestamp":1756893686000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1947-5439","authenticated-orcid":false,"given":"Stephanie F.","family":"Polites","sequence":"first","affiliation":[{"name":"Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6547-1220","authenticated-orcid":false,"given":"Jennifer H.","family":"Aldrink","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Nationwide Children's Hospital The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3323-6509","authenticated-orcid":false,"given":"Timothy B.","family":"Lautz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Ann &amp; Robert H Lurie Children's Hospital of Chicago Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Vierkant","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8803-8553","authenticated-orcid":false,"given":"Mecklin V.","family":"Ragan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Nationwide Children's Hospital The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5421-9014","authenticated-orcid":false,"given":"Audra","family":"Reiter","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Ann &amp; Robert H Lurie Children's Hospital of Chicago Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie Y.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah N.","family":"Rinehardt","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery Children's Hospital of Pittsburgh University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus M.","family":"Malek","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery Children's Hospital of Pittsburgh University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Fleming","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital and Division of Pediatric Surgery Department of Surgery University of Tennessee Health Science Center  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6747-0355","authenticated-orcid":false,"given":"Andrew J.","family":"Murphy","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital and Division of Pediatric Surgery Department of Surgery University of Tennessee Health Science Center  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Roach","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery Department of Surgery University of Colorado School of Medicine Children's Hospital Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridharan","family":"Radhakrishnan","sequence":"additional","affiliation":[{"name":"Primary Children's Hospital Unviersity of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-7539","authenticated-orcid":false,"given":"Zachary J.","family":"Kastenberg","sequence":"additional","affiliation":[{"name":"Primary Children's Hospital Unviersity of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Piche","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Centre Hospitalier Universitaire Sainte\u2010Justine Universit\u00e9 De Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Centre Hospitalier Universitaire Sainte\u2010Justine Universit\u00e9 De Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold N. 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